Provider Demographics
NPI:1043294481
Name:TAYLOR, MARTIN T (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:T
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:70 S CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1397
Mailing Address - Country:US
Mailing Address - Phone:614-890-6555
Mailing Address - Fax:614-823-8881
Practice Address - Street 1:5040 FOREST DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8167
Practice Address - Country:US
Practice Address - Phone:614-890-6555
Practice Address - Fax:614-823-8881
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007154T2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2133480Medicaid
OHTA0898836Medicare ID - Type Unspecified
OHTA0898835Medicare PIN
OHTA0898834Medicare PIN
OH2133480Medicaid