Provider Demographics
NPI:1235179516
Name:TAYLOR, ROBERT PELHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PELHAM
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3629
Mailing Address - Country:US
Mailing Address - Phone:540-949-8241
Mailing Address - Fax:540-949-5582
Practice Address - Street 1:428 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3629
Practice Address - Country:US
Practice Address - Phone:540-949-8241
Practice Address - Fax:540-949-5582
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100795207QA0505X
VA0101057041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129RJMedicaid
NC129RJMedicaid
NC129RJMedicaid
NC2291264EMedicare PIN