Provider Demographics
NPI:1588626527
Name:TAYLOR, LATIMER ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:LATIMER
Middle Name:ANTHONY
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 1:2300 RANDOLPH RD
Mailing Address - Street 2:STE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1586
Mailing Address - Country:US
Mailing Address - Phone:704-503-6336
Mailing Address - Fax:704-503-6339
Practice Address - Street 1:2300 RANDOLPH RD
Practice Address - Street 2:STE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1586
Practice Address - Country:US
Practice Address - Phone:704-503-6336
Practice Address - Fax:704-503-6339
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801527207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2258061OtherMEDICARE LEGACY NUMBER
NC8911894Medicaid
NCG81974Medicare UPIN