Provider Demographics
NPI:1730140401
Name:VAUGHAN, MAURICE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:J
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:140 CANAL VIEW BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2808
Mailing Address - Country:US
Mailing Address - Phone:585-338-2700
Mailing Address - Fax:585-242-9663
Practice Address - Street 1:140 CANAL VIEW BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2808
Practice Address - Country:US
Practice Address - Phone:585-338-2700
Practice Address - Fax:585-242-9663
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154363207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1676OtherBLUE CROSS BLUE SHIELD
PO10154363OtherEXCELLUS
000525795007OtherHEALTH NOW LINDEN OAKS
NY01095885Medicaid
5815342OtherAETNA
7701246OtherMVP
PO10154363OtherGRIPA
0005257995006OtherHEALTH NOW PARNALL
MD4261OtherPREFERRED CARE
RC60154363OtherRCIPA
0000076301506OtherUNITED HEALTHCARE
005257956OtherCOMM BLUE BCBSWNY
301134OtherWELLCARE
78480545OtherTRICARE/CHAMPUS
9702552OtherGHI
060064587OtherRAILROAD MEDICARE
NY01095885Medicaid
NY01095885Medicaid