Healthcare Provider Details

I. General information

NPI: 1447214325
Provider Name (Legal Business Name): PAULA FLANAGAN TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAIDLEY ST SAINT FRANCIS FIRST HEALTH WELLNESS CENTER
CHARLESTON WV
25301-1614
US

IV. Provider business mailing address

205 COOPERHAWK LANE
CROSS LANES WV
25313-1868
US

V. Phone/Fax

Practice location:
  • Phone: 681-313-4824
  • Fax: 681-313-4825
Mailing address:
  • Phone: 304-776-6967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20038
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20036
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number20038
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: