Healthcare Provider Details

I. General information

NPI: 1528243870
Provider Name (Legal Business Name): RICHARD C. TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9110 N ARCH VILLAGE CT SUITE F
NORTH CHESTERFIELD VA
23236-3456
US

IV. Provider business mailing address

PO BOX 36724
NORTH CHESTERFIELD VA
23235-8014
US

V. Phone/Fax

Practice location:
  • Phone: 804-683-9552
  • Fax:
Mailing address:
  • Phone: 804-683-9552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number141802
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0101249389
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number0101249389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: