1073879326 NPI number — WARD P. VAUGHAN, MD PC

Table of content: LESLIE ANN LAMAY (NPI 1881208916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073879326 NPI number — WARD P. VAUGHAN, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARD P. VAUGHAN, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WARD P VAUGHAN MD PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073879326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 AMHERST STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-665-1900
Provider Business Mailing Address Fax Number:
540-722-4805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 AMHERST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22601-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-665-0000
Provider Business Practice Location Address Fax Number:
540-722-3269
Provider Enumeration Date:
04/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHAN
Authorized Official First Name:
WARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
540-665-1900

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  0101029784 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730192485 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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