Healthcare Provider Details

I. General information

NPI: 1558367060
Provider Name (Legal Business Name): VAUGHN M COLLETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325D KENNEDY MEMORIAL DR # EF
WATERVILLE ME
04901-4530
US

IV. Provider business mailing address

174 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-5134
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-7862
  • Fax: 207-861-7869
Mailing address:
  • Phone: 207-861-3002
  • Fax: 207-861-3281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number014881
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: