Provider Demographics
NPI:1306077110
Name:WASHBURN, DOUGLAS VAUGHN (MED)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:VAUGHN
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 LORI DR
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-3904
Mailing Address - Country:US
Mailing Address - Phone:607-765-3332
Mailing Address - Fax:607-770-1446
Practice Address - Street 1:701 AZON RD FL 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1724
Practice Address - Country:US
Practice Address - Phone:607-584-0719
Practice Address - Fax:607-770-1446
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst