Provider Demographics
NPI:1326067893
Name:BLYTH, TAURA (MD)
Entity Type:Individual
Prefix:
First Name:TAURA
Middle Name:
Last Name:BLYTH
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 1:1600 MOSELEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9799
Mailing Address - Country:US
Mailing Address - Phone:585-398-1275
Mailing Address - Fax:585-398-1273
Practice Address - Street 1:1600 MOSELEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9799
Practice Address - Country:US
Practice Address - Phone:585-398-1275
Practice Address - Fax:585-398-1273
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY230335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02502683Medicaid
NY02502683Medicaid
NYI03109Medicare UPIN