Healthcare Provider Details

I. General information

NPI: 1942332408
Provider Name (Legal Business Name): AMANDA BURTON VAUGHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 MIDLOTHIAN TPKE SUITE 200
RICHMOND VA
23235-4722
US

IV. Provider business mailing address

10710 MIDLOTHIAN TPKE SUITE 200
RICHMOND VA
23235-4722
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-2100
  • Fax: 804-897-9076
Mailing address:
  • Phone: 804-897-2100
  • Fax: 804-897-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0102202616
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: