Provider Demographics
NPI:1174621791
Name:VA MEDICAL CENTER, DAYTON
Entity type:Organization
Organization Name:VA MEDICAL CENTER, DAYTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MOD
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOMAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-262-2134
Mailing Address - Street 1:6770 LEXINGTON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084010281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital