Provider Demographics
NPI:1003815168
Name:GOODING, VAUGHN G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:G
Last Name:GOODING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4336
Mailing Address - Country:US
Mailing Address - Phone:401-738-3730
Mailing Address - Fax:401-738-3777
Practice Address - Street 1:120 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4336
Practice Address - Country:US
Practice Address - Phone:401-738-3730
Practice Address - Fax:401-738-3777
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI5380207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001925Medicaid
RI7001925Medicaid
RIC65152Medicare UPIN
RI007001925Medicare PIN