Provider Demographics
NPI:1609898527
Name:VETERANS AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DHARAMRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:NIRMUL
Authorized Official - Suffix:
Authorized Official - Credentials:MBCHB, FACS, FRCS(E)
Authorized Official - Phone:570-824-3521
Mailing Address - Street 1:222 DEER RUN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1965
Mailing Address - Country:US
Mailing Address - Phone:570-474-0192
Mailing Address - Fax:
Practice Address - Street 1:1111 E END BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0030
Practice Address - Country:US
Practice Address - Phone:570-824-3521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1967-42284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital