Provider Demographics
NPI:1942332408
Name:VAUGHAN, AMANDA BURTON (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BURTON
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4722
Mailing Address - Country:US
Mailing Address - Phone:804-897-2100
Mailing Address - Fax:804-897-9076
Practice Address - Street 1:10710 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4722
Practice Address - Country:US
Practice Address - Phone:804-897-2100
Practice Address - Fax:804-897-9076
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202616207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty