Provider Demographics
NPI:1295899250
Name:TAYLOR, MICHAEL L (MD,)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
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 1:73 PITT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6181
Mailing Address - Country:US
Mailing Address - Phone:843-577-5625
Mailing Address - Fax:
Practice Address - Street 1:9330 MEDICAL PLAZA DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9104
Practice Address - Country:US
Practice Address - Phone:843-797-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23032207P00000X
NC2000-01307207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC230324Medicaid
SCH591742986Medicare PIN
SC930121667Medicare PIN
SCH591742987Medicare UPIN
SC230324Medicaid
SCH59174Medicare UPIN