MEDICARE: ELIZABETH ANN VAUGHT MS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer
2	2255A2300X	Athletic Trainer	A0000176	MD

General Provider Information

NPI Number	:	1366436685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN VAUGHT MS, ATC

Provider Business Mailing Address
First Line	:	6 SOUTHWORTH CT
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-4508
Country	:	US
Telephone Number	:	410-638-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	5114 N CHARLES ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21210-2021
Country	:	US
Telephone Number	:	410-649-3315
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	09/07/2021

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