Provider Demographics
NPI:1154399905
Name:VAUGHAN, MARY C (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-351-3455
Mailing Address - Fax:207-351-3461
Practice Address - Street 1:16 HOSPITAL DR
Practice Address - Street 2:STE C.
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1011
Practice Address - Country:US
Practice Address - Phone:207-351-3455
Practice Address - Fax:207-351-3454
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050803207V00000X
MEMD17375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1154399905Medicaid
236908OtherUHC/MAMSI
VAPAROtherCIGNA
VA-010OtherTRICARE/CHAMPUS
VA006207359Medicaid
VAPAROtherUSA MANAGED CARE
NC0633BOtherNC BC/BS
VAPAROtherMULTIPLAN
VA320762OtherANTHEM
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VA14067OtherSENTARA OPTIMA
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC890633BMedicaid
VA1154399905Medicaid
VA-010OtherTRICARE/CHAMPUS
VAPAROtherUSA MANAGED CARE
VA14067OtherSENTARA OPTIMA
VAG26161Medicare UPIN