Provider Demographics
NPI:1578503942
Name:VAUGHN, ANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:VAUGHN
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 1:5711 BIRCHVIEW PL
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4817
Mailing Address - Country:US
Mailing Address - Phone:908-472-1127
Mailing Address - Fax:
Practice Address - Street 1:5711 BIRCHVIEW PL
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4817
Practice Address - Country:US
Practice Address - Phone:908-472-1127
Practice Address - Fax:862-252-9399
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308186207R00000X
NJMA41607174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3998509Medicaid
NJ3998509Medicaid
NJ521121Medicare ID - Type Unspecified