Healthcare Provider Details

I. General information

NPI: 1336282268
Provider Name (Legal Business Name): TAYLOR MADE DIAGNOSTICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POINDEXTER ST
CHESAPEAKE VA
23324-2444
US

IV. Provider business mailing address

1001 POINDEXTER ST
CHESAPEAKE VA
23324-2444
US

V. Phone/Fax

Practice location:
  • Phone: 757-494-1688
  • Fax: 757-494-1973
Mailing address:
  • Phone: 757-494-1688
  • Fax: 757-494-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRIS MIDGETT
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-494-1688