Individual
GERALD LANE DEVAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5249 CEDAR AVE, SUITE A, PHILADELPHIA, PA 19143-1524
(215) 471-1817
(215) 471-5089
Mailing address
5249 CEDAR AVE, SUITE A, PHILADELPHIA, PA 19143-1524
(215) 471-1817
(215) 471-5089
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD024220E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009504130009
—
PA
Enumeration date
11/15/2006
Last updated
03/16/2016
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