Healthcare Provider Details

I. General information

NPI: 1134082696
Provider Name (Legal Business Name): MR. CHRISTOPHER DAMOND TAYLOR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 LENTEN ROSE LN
RICHMOND VA
23223-5862
US

IV. Provider business mailing address

627 LENTEN ROSE LN
RICHMOND VA
23223-5862
US

V. Phone/Fax

Practice location:
  • Phone: 804-572-9710
  • Fax:
Mailing address:
  • Phone: 804-572-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberT67132780
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: