Provider Demographics
NPI:1598127235
Name:TAYLOR, MARK ANTHONY II (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:TAYLOR
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:29 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1796
Mailing Address - Country:US
Mailing Address - Phone:413-854-9638
Mailing Address - Fax:
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1796
Practice Address - Country:US
Practice Address - Phone:413-854-9638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA291678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10498706-8905OtherSTATE OF UTAH DEPARTMENT OF COMMERCE
MA291678OtherMASSACHUSETTS BOARD OF REGISTRATION IN MEDICINE
MAMCS008640AOtherMCSC