Provider Demographics
NPI:1972641926
Name:VAUGHAN, WILLIAM E JR (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:VAUGHAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD
Mailing Address - Street 2:SUITE #400
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1216
Mailing Address - Country:US
Mailing Address - Phone:215-481-3064
Mailing Address - Fax:
Practice Address - Street 1:2026 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1004
Practice Address - Country:US
Practice Address - Phone:215-368-4344
Practice Address - Fax:215-361-7579
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51937207Q00000X
NC2018-01137207Q00000X
IN02005386A207Q00000X
TXR8507207Q00000X
DCDO034759207Q00000X
VA0102201899207Q00000X, 208D00000X
PAOS016142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102915668Medicaid
PA102915668Medicaid