Provider Demographics
NPI:1700835915
Name:TAYLOR, DANIEL RANDOLPH (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RANDOLPH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 WESTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3528
Mailing Address - Country:US
Mailing Address - Phone:215-848-6933
Mailing Address - Fax:
Practice Address - Street 1:231 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1511
Practice Address - Country:US
Practice Address - Phone:215-523-6601
Practice Address - Fax:215-523-6800
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009985L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018626470001Medicaid
PA051961Medicare ID - Type Unspecified
PA0018626470001Medicaid