Healthcare Provider Details

I. General information

NPI: 1124260849
Provider Name (Legal Business Name): KEVIN VAUGHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 06/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 5TH AVE CHILDREN'S HOSPITAL OF PITTSBURGH
PITTSBURGH PA
15213-2584
US

IV. Provider business mailing address

1604 DENNISTON ST SUITE 3950
PITTSBURGH PA
15217-1458
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD434218
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: