Provider Demographics
NPI:1851368914
Name:TAYLOR, TIMOTHY N (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:N
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:PO BOX 932085
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0007
Mailing Address - Country:US
Mailing Address - Phone:216-267-5139
Mailing Address - Fax:216-267-5133
Practice Address - Street 1:18660 BAGLEY RD STE 405
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-826-3030
Practice Address - Fax:440-826-1235
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003215T207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1780634279OtherGROUP NPI
CA4511OtherRR MEDICARE GROUP
290015145OtherRR MEDICARE INDIVIDUAL
112730OtherKAISER
OH0514894Medicaid
3610861OtherGROUP ASC MEDICARE
D368301OtherGROUP IND DIAGNOSTICS
OH2001738OtherGROUP MEDICAID
9273172OtherGROUP MEDICARE
10800279OtherCAQH
OH9287148OtherGROUP MEDICARE
9273172OtherGROUP MEDICARE
B77572Medicare UPIN