Provider Demographics
NPI:1659337343
Name:VAUGHN, DAVID ROBINSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBINSON
Last Name:VAUGHN
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 1:106 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-4434
Mailing Address - Country:US
Mailing Address - Phone:434-528-1213
Mailing Address - Fax:
Practice Address - Street 1:1922 THOMSON DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1099
Practice Address - Country:US
Practice Address - Phone:434-845-7392
Practice Address - Fax:434-845-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234526207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06064OtherMEDICARE GROUP
P00240503OtherRAILROAD MEDICARE
178016OtherANTHEM BLUECROSSBLUESHIEL
VA010180384Medicaid
VAC06064OtherMEDICARE GROUP
P00240503OtherRAILROAD MEDICARE
VA008390A64Medicare PIN