Provider Demographics
NPI:1225295116
Name:TAYLOR, MELBA MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:MELBA
Middle Name:MARGARET
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1793 RIVERSIDE DR
Mailing Address - Street 2:APT 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5335
Mailing Address - Country:US
Mailing Address - Phone:240-353-6718
Mailing Address - Fax:
Practice Address - Street 1:405 WEST JACKSON STREET
Practice Address - Street 2:MEMORIAL HOSPITAL OF CARBONDALE EMERGENCY SERVICES
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-549-0721
Practice Address - Fax:618-457-0469
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036143045207P00000X
NY245926207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036143045Medicaid