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NPI Code Detail

MEDICARE: DR. JOEL FULLER VAUGHAN MD

MEDICARE: DR. JOEL FULLER VAUGHAN MD
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
1208000000XPediatrics Physician23927SC
2207R00000XInternal Medicine Physician23927SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457305104
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOEL FULLER VAUGHAN MD
Provider Business Mailing Address
First Line : 2200 SANDPIPER RD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-4620
Country : US
Telephone Number : 843-556-9785
Fax Number :
Provider Business Practice Location Address
First Line : 109 BEE ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29401-5703
Country : US
Telephone Number : 843-577-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 06/12/2019

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Directions to “ DR. JOEL FULLER VAUGHAN MD” Practice Location

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