Provider Demographics
NPI:1780659706
Name:VAUGHAN, NATHAN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:ANDREW
Last Name:VAUGHAN
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 1:1249 15TH ST STE 4000
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3663
Mailing Address - Country:US
Mailing Address - Phone:304-691-8500
Mailing Address - Fax:304-691-8550
Practice Address - Street 1:300 CORPORATE CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560
Practice Address - Country:US
Practice Address - Phone:304-691-6732
Practice Address - Fax:304-691-6919
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13194207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084955000Medicaid
WV0583302Medicare ID - Type Unspecified
WV0084955000Medicaid