Healthcare Provider Details

I. General information

NPI: 1669521332
Provider Name (Legal Business Name): DAVID WESLEY VAUGHN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15108 REDGATE DR
SILVER SPRING MD
20905-5729
US

IV. Provider business mailing address

15108 REDGATE DR
SILVER SPRING MD
20905-5729
US

V. Phone/Fax

Practice location:
  • Phone: 301-879-2388
  • Fax:
Mailing address:
  • Phone: 301-879-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00026233
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01034261A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: