Provider Demographics
NPI:1538323423
Name:VAUGHAN, CARL SHERWOOD (MED)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:SHERWOOD
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11408 LONG MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5101
Mailing Address - Country:US
Mailing Address - Phone:804-239-0846
Mailing Address - Fax:804-264-6131
Practice Address - Street 1:11408 LONG MEADOW DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5101
Practice Address - Country:US
Practice Address - Phone:804-239-0846
Practice Address - Fax:804-264-6131
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor