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General NPI Number Information
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NPI Number | 1144216987
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Entity Type | Individual
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Provider Name | CHARLES M VAUGHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 11803 JEFFERSON AVE SUITE 110
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2565
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Country | US
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Telephone | 757-873-0360
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Fax | 757-873-0847
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1318
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Country | US
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Telephone | 757-594-4006
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Fax | 757-534-5190
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 0101042292
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 0101042292
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License Number State | VA
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