Individual provider Active NPI

Mary Tayal, PHD

  • Psychologist
  • Charlotte, NC
National Provider Identifier
1376639724
Registry record updated Oct 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
1833 Issued in NC
Practice address
3541 Randolph Rd
Suite 206
Charlotte, NC 28211-1082
Phone
(704) 381-8336
NPI assigned
Oct 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1833 NC Primary

Addresses

Primary practice location

3541 Randolph Rd
Suite 206
Charlotte, NC 28211-1082

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140821002568 NC Practitioner - Clinical Psychologist 0840392973 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thriveworks Clinical - North Carolina PCGroup PAC ID 8527471200, 109 clinicians

Practice addresses (Care Compare)

505 S Duke St
Suite 302
Durham, NC 27701-3199
Phone (855) 284-7483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Thriveworks Clinical - North Carolina PC CurrentSince Jun 1, 2022 Accepting new patients

Locations

119 SW Maynard Rd
Cary, NC 27511
Phone (919) 415-1112

505 S Duke St
Ste 302
Durham, NC 27701
Phone (571) 493-3535

1000 Jefferson St
Ste 2C
Lynchburg, VA 24504
Phone (434) 528-3263

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570147200000",
    "number": "1376639724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 RANDOLPH RD",
            "address_2": "SUITE 206",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111082",
            "telephone_number": "704-381-8336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYAL",
        "first_name": "MARY",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2019-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "1833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.