1497141402 NPI number — JAMILLE PATRICE TAYLOR MD

Table of content: JAMILLE PATRICE TAYLOR MD (NPI 1497141402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497141402 NPI number — JAMILLE PATRICE TAYLOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
JAMILLE
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1497141402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4920 CAMPBELL BLVD
Provider Second Line Business Mailing Address:
ACUTE CARE SERVICES
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
109-337-6004
Provider Business Mailing Address Fax Number:
410-933-7667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 CAMPBELL BLVD
Provider Second Line Business Practice Location Address:
ACUTE CARE SERVICES
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
109-337-6004
Provider Business Practice Location Address Fax Number:
410-933-7667
Provider Enumeration Date:
04/07/2015

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: 207Q00000X , with the licence number:  D85606 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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