Provider Demographics
NPI:1427001437
Name:TAYLOR, CRAIG LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:LESLIE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2718
Mailing Address - Country:US
Mailing Address - Phone:215-248-8506
Mailing Address - Fax:215-248-8091
Practice Address - Street 1:8835 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2718
Practice Address - Country:US
Practice Address - Phone:215-248-8506
Practice Address - Fax:215-248-8091
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME818152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009539160006Medicaid
PA135195EQXMedicare PIN
FLD76009Medicare UPIN
PA0009539160006Medicaid