Provider Demographics
NPI:1558367060
Name:COLLETT, VAUGHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:M
Last Name:COLLETT
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 1:174 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5134
Mailing Address - Country:US
Mailing Address - Phone:207-861-3002
Mailing Address - Fax:207-861-3281
Practice Address - Street 1:325D KENNEDY MEMORIAL DR # EF
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4530
Practice Address - Country:US
Practice Address - Phone:207-861-7862
Practice Address - Fax:207-861-7869
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014881207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME036815OtherANTHEM STAR ID#
ME262020099Medicaid
ME036815OtherANTHEM STAR ID#
G84845Medicare UPIN