Provider Demographics
NPI:1821626540
Name:DIBBLE, TAYLOR R (MD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:R
Last Name:DIBBLE
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 1:7 N COLUMBUS BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1450
Mailing Address - Country:US
Mailing Address - Phone:215-512-8058
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:215-746-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program