1497793269 NPI number — GREGORY G TAYLOR CRNA

Table of content: GREGORY G TAYLOR CRNA (NPI 1497793269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497793269 NPI number — GREGORY G TAYLOR CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
GREGORY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1497793269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3810 WATERSIDE DR
Provider Second Line Business Mailing Address:
#104
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909-9738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-538-5352
Provider Business Mailing Address Fax Number:
252-621-1003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3810 WATERSIDE DR
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909-9738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-538-5352
Provider Business Practice Location Address Fax Number:
252-621-1003
Provider Enumeration Date:
06/03/2006

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: 367500000X , with the licence number:  RO96528 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 158154 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 424601200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com