Provider Demographics
NPI:1942244843
Name:TAYLOR, PHILIP C (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:C
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 1:3615 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-2746
Mailing Address - Fax:
Practice Address - Street 1:3615 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-2746
Practice Address - Fax:610-387-4526
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023260E207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TA161829OtherHIGHMARK BLUE SHIELD
0045875000OtherKEYSTONE
0045875002OtherBCBS HIGHMARK KEYSTONE
PA0008866080006Medicaid
04-32948OtherEVERCARE
161829R3WMedicare PIN
0045875000OtherKEYSTONE
C32419Medicare UPIN