Provider Demographics
NPI:1184697542
Name:TAYLOR, DAVID A (MA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13784 WARWICK BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-5481
Mailing Address - Country:US
Mailing Address - Phone:757-877-4000
Mailing Address - Fax:757-877-1373
Practice Address - Street 1:13784 WARWICK BLVD STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5481
Practice Address - Country:US
Practice Address - Phone:757-877-4000
Practice Address - Fax:757-877-1373
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001175231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA640000131Medicare UPIN