Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 274930 | MA |
N | 2080P0208X | Pediatric Infectious Diseases | MT209054 | PA |
NPI | 1366763062 |
---|---|
Provider Name | Ms. Ana Vaughan |
First Address | Haverford, PA 19041-1558 |
Second Address | Boston, MA 02115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 30/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
823974 | (05) | AZ |