Provider Demographics
NPI:1225598089
Name:TRUSSELL, TAYLOR M (MD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:TRUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:MLC 2003
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-803-4574
Mailing Address - Fax:513-803-4493
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:MLC 2003
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-803-4574
Practice Address - Fax:513-803-4493
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program