Provider Demographics
NPI:1548229123
Name:TAYLOR, MARGO ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:253 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1501
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-7023
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036529A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184392OtherANTHEM PROVIDER NUMBER
IN100086610Medicaid
IN9397546OtherPHCS PID NUMBER
IN10826072OtherCAQH NUMBER
INTA15506011Medicaid
INTA15506011Medicaid
IN000000184392OtherANTHEM PROVIDER NUMBER
IND50480Medicare UPIN
IN930061544Medicare PIN
IN815500EEMedicare PIN