1861460354 NPI number — DONALD KENWOOD TAYLOR O.D.

Table of content: DAYNA D'ALESSIO (NPI 1447826805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861460354 NPI number — DONALD KENWOOD TAYLOR O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
DONALD
Provider Middle Name:
KENWOOD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861460354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUEFIELD
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24701-4038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-325-8685
Provider Business Mailing Address Fax Number:
304-324-0429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24701-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-325-8685
Provider Business Practice Location Address Fax Number:
304-324-0429
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  689-OD , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001719832 . This is a "MT STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 009204342 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0150605000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0452014 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0452015 . This is a "ANTHEM BC BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 037848 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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