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General NPI Number Information
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NPI Number | 1518378942
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Entity Type | Individual
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Provider Name | CAROLYN EDSON TAILLON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR NAVAL MEDICAL CENTER PORTSMOUTH
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-953-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9992
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 0101258786
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License Number State | VA
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