Provider Demographics
NPI:1922023118
Name:TAYLOR, PETER CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHARLES
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 1:661 W FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3104
Mailing Address - Country:US
Mailing Address - Phone:360-481-4086
Mailing Address - Fax:540-886-5776
Practice Address - Street 1:800 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4420
Practice Address - Country:US
Practice Address - Phone:434-979-0366
Practice Address - Fax:434-245-0403
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010125928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG94853Medicare UPIN
VAVV8764AMedicare PIN