Provider Demographics
NPI:1528024049
Name:TAYLOR, CHARLES ALLEN II (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALLEN
Last Name:TAYLOR
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4899 CLIFFSIDE ST
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:NC
Mailing Address - Zip Code:28609-8102
Mailing Address - Country:US
Mailing Address - Phone:828-241-1179
Mailing Address - Fax:
Practice Address - Street 1:4899 CLIFFSIDE ST
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:NC
Practice Address - Zip Code:28609-8102
Practice Address - Country:US
Practice Address - Phone:828-241-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA888213E00000X
WV256213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
406480239OtherRAILROAD MEDICARE
WV0099722000Medicaid
WV0099722000Medicaid