Basic Information
| Provider Information | |||||||||
| NPI: | 1982845327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | LORENE | ||||||||
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| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4607 MACCORKLE AVE SW STE 204 | ||||||||
| Address2: | |||||||||
| City: | S CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253091364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047677930 | ||||||||
| FaxNumber: | 3047677935 | ||||||||
| Practice Location | |||||||||
| Address1: | 4607 MACCORKLE AVE SW STE 204 | ||||||||
| Address2: | |||||||||
| City: | S CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253091364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043882525 | ||||||||
| FaxNumber: | 3043882537 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2009 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | WV2481 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.