Provider Demographics
NPI:1942428438
Name:TAHLOR, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:TAHLOR
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 1:170 EVERGREEN RD
Mailing Address - Street 2:12B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2444
Mailing Address - Country:US
Mailing Address - Phone:908-930-5167
Mailing Address - Fax:
Practice Address - Street 1:170 EVERGREEN RD
Practice Address - Street 2:12B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2444
Practice Address - Country:US
Practice Address - Phone:908-930-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine