1952390007 NPI number — DR. GARY L TAYLOR M.D.

Table of content: DR. GARY L TAYLOR M.D. (NPI 1952390007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952390007 NPI number — DR. GARY L TAYLOR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
GARY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952390007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
69 WILMINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORCHESTER CENTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02124-4512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-436-8968
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 DORCHESTER AVE
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
DORCHESTER CENTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02124-5628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-296-0456
Provider Business Practice Location Address Fax Number:
617-296-1655
Provider Enumeration Date:
10/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  53555 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0401251 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J05571 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000020228 . This is a "BOSTON HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 709833 . This is a "TUFTS ASSOCIATED HEALTH P" identifier . This identifiers is of the category "OTHER".
  • Identifier: 92477 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: B10127801 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3037444 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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