Provider Demographics
NPI:1558323824
Name:MAUGHAN, GEORGE T (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:T
Last Name:MAUGHAN
Suffix:
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 1:425 N BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3306
Mailing Address - Country:US
Mailing Address - Phone:804-358-0248
Mailing Address - Fax:804-358-9477
Practice Address - Street 1:425 N BOULEVARD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3306
Practice Address - Country:US
Practice Address - Phone:804-358-0248
Practice Address - Fax:804-358-9477
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083673701OtherGROUP NPI NUMBER
VA110125661OtherMEDICARE RAILROAD
VA005699673Medicaid
1083673701OtherGROUP NPI NUMBER
080005421Medicare ID - Type Unspecified