Provider Demographics
NPI:1386854107
Name:TAYLOR, LAINE ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:LAINE
Middle Name:ELIZABETH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LANE
Other - Middle Name:ELIZABETH
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:230 S FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1124
Mailing Address - Country:US
Mailing Address - Phone:480-206-2928
Mailing Address - Fax:
Practice Address - Street 1:230 S FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1124
Practice Address - Country:US
Practice Address - Phone:480-206-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR8902084P0800X
CT0478862084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR890OtherTRAINING LICENSE
CT047886OtherMEDICAL LICENSE
FLOS11578OtherLICENSE