John Stafford Taylor, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9601084 Issued in NC

Practice address

104 Mark Dr
Edenton, NC 27932-1756

Phone

(252) 482-5171

Fax

(252) 482-5173

NPI assigned

Oct 20, 2005

Last updated

Dec 16, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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

• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  Medicare reassignment NPD
• Edenton Internal Medicine PA

  • Internal Medicine Physician
  • Edenton, NC
  • NPI 1104816396
  NPD

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260921600000",
    "number": "1932198090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321210",
            "telephone_number": "252-482-5171",
            "fax_number": "252-482-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MARK DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321756",
            "telephone_number": "252-482-5171",
            "fax_number": "252-482-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "JOHN",
        "middle_name": "STAFFORD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2009-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9601084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8982105",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marvin Nelson Spear, PHARMD
• Jessica Spruill, PTA
• Sierra Swain, LCSW-A
• Robert Nathan Sykes Jr., PHARMACIST
• Tar River LTC Group, LLC (Chowan River Nursing and Rehabilitation Center)
• Joseph Gaston Taylor III, MD
• Mehm T Thaung, MD
• Thomas Learning Solutions LLC
• Cindy S Thomas, L.P.C.,L.C.A.S.
• Rachel Thomas, M.S., CCC-SLP

• Internal Medicine Physician in Edenton, NC
• Providers in Edenton, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.