Provider Demographics
NPI:1073176673
Name:VAUGHAN, MARK TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:TAYLOR
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-967-8622
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2025 GLENN MITCHELL DR
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0178
Practice Address - Country:US
Practice Address - Phone:757-967-8622
Practice Address - Fax:757-686-0541
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2022-01663207R00000X
VA0101278291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine