Provider Demographics
NPI:1144652603
Name:YOLANDA K. VAUGHAN MDPC
Entity type:Organization
Organization Name:YOLANDA K. VAUGHAN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-638-0418
Mailing Address - Street 1:3475 LEONARDTOWN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3678
Mailing Address - Country:US
Mailing Address - Phone:301-638-0418
Mailing Address - Fax:
Practice Address - Street 1:3475 LEONARDTOWN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3678
Practice Address - Country:US
Practice Address - Phone:301-638-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038204207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD157RMedicare UPIN