Provider Demographics
NPI:1528066297
Name:TAYLOR, CHARLES D (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
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:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0347
Mailing Address - Country:US
Mailing Address - Phone:434-392-9449
Mailing Address - Fax:434-392-5530
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1199
Practice Address - Country:US
Practice Address - Phone:434-392-9449
Practice Address - Fax:434-392-5530
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037122208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4518275OtherAETNA PROVIDER NUMBER
VA20033OtherCARENET/SOUTHERN HEALTH
VA180564OtherSOUTHERN HEALTH
VA082156OtherANTHEM BCBS
340001025OtherRAILROAD MEDICARE PIN
VA202908OtherCIGNA HEALTHCARE
VA007533641Medicaid
VA2102078OtherMAMSI HEALTHCARE
VA4518275OtherAETNA PROVIDER NUMBER
VAB05405Medicare UPIN
VA340000122Medicare PIN