Active NPI
Robert W Vaughan, M.D.
- Family Medicine Physician
- Petersburg, VA
National Provider Identifier
1255401303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101033382
- Practice address
- 315 Brown St
Petersburg, VA 23803-4232 - Phone
- (804) 518-1220
- Fax
- (804) 518-1453
- NPI assigned
- Nov 8, 2006
- Last updated
- Oct 2, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101033382 | VA | Primary |
Addresses
Primary practice location
315 Brown St
Petersburg, VA 23803-4232
Mailing address
856 J Clyde Morris Blvd
Suite a
Newport News, VA 23601-1318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101033382 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bon Secours-Virginia Healthsource | Family Medicine | Past | Accepting new patients |
| Harness Health Pharmacy - Central Pharmacy Services LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Tuckahoe Family Medical Center
- Family Medicine Physician
- Richmond, VA
- NPI 1528091808
-
dba Harness Health Pharmacy #502
- Community/Retail Pharmacy
- Richmond, VA
- NPI 1619222767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1255401303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "856 J CLYDE MORRIS BLVD",
"address_2": "SUITE A",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236011318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 BROWN ST",
"city": "PETERSBURG",
"state": "VA",
"postal_code": "238034232",
"telephone_number": "804-518-1220",
"fax_number": "804-518-1453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAUGHAN",
"first_name": "ROBERT",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101033382",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Petersburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.