Provider Demographics
NPI:1386790772
Name:TAYLOR, MARY B (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3200 MACCORKLE SEAVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-5550
Mailing Address - Fax:304-388-4352
Practice Address - Street 1:3200 MACCORKLE AVENUE SE,
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5550
Practice Address - Fax:304-388-4352
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV09409207ZP0105X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TA7132881Medicare PIN
WVE77946Medicare UPIN
WV5100821Medicare PIN
TA4208542Medicare PIN