Healthcare Provider Details

I. General information

NPI: 1932687522
Provider Name (Legal Business Name): TAYLOR MARIE BEARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 BELMONT AVE
YOUNGSTOWN OH
44504-1007
US

IV. Provider business mailing address

1053 BELMONT AVE
YOUNGSTOWN OH
44504-1007
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-7350
  • Fax: 330-746-7436
Mailing address:
  • Phone: 330-480-7350
  • Fax: 330-746-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005620RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number50.005620RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: