Provider Demographics
NPI:1861439101
Name:MANCHESTER VAMC
Entity Type:Organization
Organization Name:MANCHESTER VAMC
Other - Org Name:PORTSMOUTH VA CBOC
Other - Org Type:Other Name
Authorized Official - Title/Position:NPI TEAM MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-382-2579
Mailing Address - Street 1:PO BOX 94441
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-4441
Mailing Address - Country:US
Mailing Address - Phone:717-277-6565
Mailing Address - Fax:
Practice Address - Street 1:302 NEWMARKET ST
Practice Address - Street 2:BUILDING 15, PEASE AIR NATIONAL GUARD BASE
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03803-0001
Practice Address - Country:US
Practice Address - Phone:717-277-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA