Provider Demographics
NPI:1134112584
Name:VAUGHT, BRIAN (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PAVIA CT
Mailing Address - Street 2:APT. 2B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4361
Mailing Address - Country:US
Mailing Address - Phone:410-687-0393
Mailing Address - Fax:
Practice Address - Street 1:11152 FALLS ROAD
Practice Address - Street 2:DEPT. OF ATHLETICS--TRAINING ROOM
Practice Address - City:BROOKLANDVILLE
Practice Address - State:MD
Practice Address - Zip Code:21022
Practice Address - Country:US
Practice Address - Phone:410-821-3039
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer