Provider Demographics
NPI:1073879326
Name:WARD P. VAUGHAN, MD PC
Entity Type:Organization
Organization Name:WARD P. VAUGHAN, MD PC
Other - Org Name:WARD P VAUGHAN MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-665-1900
Mailing Address - Street 1:1330 AMHERST STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3000
Mailing Address - Country:US
Mailing Address - Phone:540-665-1900
Mailing Address - Fax:540-722-4805
Practice Address - Street 1:1330 AMHERST STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3000
Practice Address - Country:US
Practice Address - Phone:540-665-0000
Practice Address - Fax:540-722-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029784207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730192485Medicaid