Provider Demographics
NPI:1104956770
Name:IFILL TAYLOR, DARLENE C (MD)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:C
Last Name:IFILL TAYLOR
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 1:1515 MOCKINGBIRD LN STE 360
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1172
Mailing Address - Country:US
Mailing Address - Phone:980-938-5001
Mailing Address - Fax:980-999-5022
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 360
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1172
Practice Address - Country:US
Practice Address - Phone:980-938-5001
Practice Address - Fax:980-999-5022
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDO0380442084P0800X
DCMD182382084P0800X
NC2015-009802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
651597Medicare ID - Type Unspecified
F4376Medicare UPIN