Provider Demographics
NPI:1962497107
Name:TAYLOR, NOAH A (MD)
Entity Type:Individual
Prefix:DR
First Name:NOAH
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2368
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2368
Mailing Address - Country:US
Mailing Address - Phone:812-474-1110
Mailing Address - Fax:812-474-1303
Practice Address - Street 1:700 N BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2740
Practice Address - Country:US
Practice Address - Phone:812-474-1110
Practice Address - Fax:812-474-1303
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070529A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201045650Medicaid
IN201045650Medicaid
INM400061861Medicare PIN
INH81365Medicare UPIN
INK067690Medicare PIN