Provider Demographics
NPI:1588352793
Name:TALIAFERRO, WAYNE RICHARD
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:RICHARD
Last Name:TALIAFERRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-2839
Mailing Address - Country:US
Mailing Address - Phone:804-921-8313
Mailing Address - Fax:
Practice Address - Street 1:2242 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-2839
Practice Address - Country:US
Practice Address - Phone:804-921-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT63663367347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle