Provider Demographics
NPI:1083144778
Name:VAUGHN-VALENCIA, MICAH MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:MARTIN
Last Name:VAUGHN-VALENCIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E MARSHALL STREET
Mailing Address - Street 2:BOX 980034
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0034
Mailing Address - Country:US
Mailing Address - Phone:903-327-5546
Mailing Address - Fax:
Practice Address - Street 1:1001 E LEIGH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5004
Practice Address - Country:US
Practice Address - Phone:804-828-4409
Practice Address - Fax:804-806-7588
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8260207V00000X
OK38003207V00000X
TXBP10060908207V00000X
VA0101281541207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology