Provider Demographics
NPI:1346257219
Name:VAUGHEY, ELLEN CLARKE (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CLARKE
Last Name:VAUGHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:#350
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-641-8616
Mailing Address - Fax:703-641-9468
Practice Address - Street 1:3289 WOODBURN RD
Practice Address - Street 2:#350
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-641-8616
Practice Address - Fax:703-641-9468
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049705207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006096948Medicaid
119005Medicare ID - Type Unspecified