Provider Demographics
NPI:1376544460
Name:TAYLOR, KERRI A (DO)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-0317
Mailing Address - Country:US
Mailing Address - Phone:315-824-6652
Mailing Address - Fax:315-824-6544
Practice Address - Street 1:5180 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13409-4058
Practice Address - Country:US
Practice Address - Phone:315-495-2690
Practice Address - Fax:315-495-3915
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY204801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G65480Medicare UPIN