Provider Demographics
NPI:1396855573
Name:TAYLOR, JAIME C (PAC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:C
Last Name:TAYLOR
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Gender:F
Credentials:PAC
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Mailing Address - Street 1:3100 WYMAN PARK DRIVE
Mailing Address - Street 2:SUITE 359A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211
Mailing Address - Country:US
Mailing Address - Phone:410-338-3016
Mailing Address - Fax:410-338-3420
Practice Address - Street 1:137 MITCHELLS CHANCE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2787
Practice Address - Country:US
Practice Address - Phone:410-224-8220
Practice Address - Fax:410-841-2482
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-09
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Provider Licenses
StateLicense IDTaxonomies
MDC02146363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS90096Medicare UPIN
B68292Medicare UPIN