MEDICARE: GERALD BERNARD TAYLOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	88630	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184649261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD BERNARD TAYLOR MD

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1470 TOBIAS GADSON BLVD STE 110
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4835
Country	:	US
Telephone Number	:	843-402-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	09/10/2024

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