Provider Demographics
NPI:1982845327
Name:TAYLOR, REBECCA LORENE (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LORENE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 MACCORKLE AVE SW STE 204
Mailing Address - Street 2:
Mailing Address - City:S CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-767-7930
Mailing Address - Fax:304-767-7935
Practice Address - Street 1:4607 MACCORKLE AVE SW STE 204
Practice Address - Street 2:
Practice Address - City:S CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-388-2525
Practice Address - Fax:304-388-2537
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV2481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics