Provider Demographics
NPI:1801869607
Name:TAYLOR, MARK M (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:511 ROANOKE BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5032
Mailing Address - Country:US
Mailing Address - Phone:540-375-2686
Mailing Address - Fax:540-375-2688
Practice Address - Street 1:511 ROANOKE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5032
Practice Address - Country:US
Practice Address - Phone:540-375-2686
Practice Address - Fax:540-375-2688
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2014-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101058096207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005618541Medicaid
VA005618541Medicaid
H24765Medicare UPIN
VA003740W08Medicare ID - Type Unspecified
VA018107C18Medicare PIN
VAMC12515Medicare PIN