Provider Demographics
NPI:1518196716
Name:TAYLOR, HENRY GORDON (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:GORDON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5219
Mailing Address - Country:US
Mailing Address - Phone:304-610-1139
Mailing Address - Fax:
Practice Address - Street 1:290 S CENTER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5219
Practice Address - Country:US
Practice Address - Phone:410-876-4943
Practice Address - Fax:410-996-5179
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027934207R00000X
WV13188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD026710400Medicaid
MD166311Y82Medicare PIN