Provider Demographics
NPI:1063478030
Name:VAUGHAN, ROBERT T JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:VAUGHAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3747
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:4 SHAPE DR
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6601
Practice Address - Country:US
Practice Address - Phone:207-467-8988
Practice Address - Fax:207-467-8969
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027406OtherANTHEM
ME610006001OtherCIGNA
ME2074076OtherAETNA
MED23880OtherHARVARD PILGRIM
ME310110099Medicaid
ME310110099Medicaid
ME2074076OtherAETNA
MED23880OtherHARVARD PILGRIM