Provider Demographics
NPI:1548426836
Name:TAYLOR, VIVIAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 STATE RD
Mailing Address - Street 2:HOC MOD II
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2908
Mailing Address - Country:US
Mailing Address - Phone:215-335-5877
Mailing Address - Fax:
Practice Address - Street 1:8001 STATE RD
Practice Address - Street 2:HOC MOD II
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2908
Practice Address - Country:US
Practice Address - Phone:215-335-5877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000164L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical