Provider Demographics
NPI:1780439810
Name:STACK, TAYLOR JO (MD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:JO
Last Name:STACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 MANNING DRIVE
Mailing Address - Street 2:CB 7070
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7025
Mailing Address - Country:US
Mailing Address - Phone:919-966-3343
Mailing Address - Fax:991-996-6794
Practice Address - Street 1:170 MANNING DRIVE
Practice Address - Street 2:CB 7070
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7025
Practice Address - Country:US
Practice Address - Phone:984-984-6484
Practice Address - Fax:991-996-6794
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program