Healthcare Provider Details

I. General information

NPI: 1982643284
Provider Name (Legal Business Name): DANIELLE M THOMAS-TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OWEN DRIVE
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1601 OWEN DRIVE
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-0100
  • Fax: 910-678-7274
Mailing address:
  • Phone: 910-678-0100
  • Fax: 910-678-7274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number228507
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number228507
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number2012-00749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: