Provider Demographics
NPI:1518317007
Name:TAYLOR, TIMOTHY II
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:TAYLOR
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-1624
Mailing Address - Country:US
Mailing Address - Phone:814-449-1164
Mailing Address - Fax:
Practice Address - Street 1:140 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-1624
Practice Address - Country:US
Practice Address - Phone:814-449-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical