Provider Demographics
NPI:1659389856
Name:DEFOREST, VAUGHN C (MD)
Entity Type:Individual
Prefix:
First Name:VAUGHN
Middle Name:C
Last Name:DEFOREST
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:MID COAST HOSPITAL
Mailing Address - Street 2:123 MEDICAL CENTER DR.
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-373-6086
Mailing Address - Fax:207-373-6080
Practice Address - Street 1:MID COAST HOSPITAL
Practice Address - Street 2:123 MEDICAL CENTER DR.
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-373-6086
Practice Address - Fax:207-373-6080
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME061028207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208M00000XAllopathic & Osteopathic PhysiciansHospitalist