Provider Demographics
NPI:1295465714
Name:TAYLORED UROGYN CARE
Entity Type:Organization
Organization Name:TAYLORED UROGYN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROGYNECOLOGIC SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:KHALALI
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-450-4883
Mailing Address - Street 1:2657G ANNAPOLIS RD # 327
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1262
Mailing Address - Country:US
Mailing Address - Phone:667-274-3333
Mailing Address - Fax:
Practice Address - Street 1:2164 NOTTOWAY DRIVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1095
Practice Address - Country:US
Practice Address - Phone:667-274-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical