Provider Demographics
NPI:1669521332
Name:VAUGHN, DAVID WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WESLEY
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 1:15108 REDGATE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5729
Mailing Address - Country:US
Mailing Address - Phone:301-879-2388
Mailing Address - Fax:
Practice Address - Street 1:15108 REDGATE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5729
Practice Address - Country:US
Practice Address - Phone:301-879-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026233208000000X
IN01034261A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics