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General NPI Number Information
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NPI Number | 1154411908
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Entity Type | Organization
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Legal Business Name | AMY A VAUGHAN DERMATOLOGY PLLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6007 US RT 60 EAST SUITE 130
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City | BARBOURSVILLE
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State | WV
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Zip | 25504
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Country | US
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Telephone | 304-733-3333
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Fax | 304-733-3666
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Provider Business Mailing Address
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Address Line | PO BOX 937 6007 US RT 60 E SUITE 130
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City | BARBOURSVILLE
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State | WV
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Zip | 25504
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Country | US
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Telephone | 304-733-3333
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Fax | 304-733-3666
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | AMY A VAUGHAN
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Credential | MD
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Telephone | 304-733-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 18579
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License Number State | WV
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