MEDICARE: TAYLOR D HOLLIDAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101039694	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477571743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR D HOLLIDAY MD

Provider Business Mailing Address
First Line	:	16431 WISE ST.
Second Line	:
City	:	SAINT PAUL
State	:	VA
Zip	:	24283
Country	:	US
Telephone Number	:	276-762-2300
Fax Number	:	276-762-0612

Provider Business Practice Location Address
First Line	:	16431 WISE ST.
Second Line	:
City	:	SAINT PAUL
State	:	VA
Zip	:	24283
Country	:	US
Telephone Number	:	276-762-2300
Fax Number	:	276-762-0612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/04/2010

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