Provider Demographics
NPI:1760484703
Name:TAYLOR, HARVEY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:ALLEN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1271
Mailing Address - Country:US
Mailing Address - Phone:508-485-1079
Mailing Address - Fax:508-485-0899
Practice Address - Street 1:65 FREMONT ST
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:MA
Practice Address - Zip Code:01752-1271
Practice Address - Country:US
Practice Address - Phone:508-485-1079
Practice Address - Fax:508-485-0899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9712682Medicaid
MAM11751Medicare ID - Type Unspecified
MAB97014Medicare UPIN