Provider Demographics
NPI:1013476282
Name:TAYLOR, FREDERICK G
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:G
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3710
Mailing Address - Country:US
Mailing Address - Phone:215-681-1568
Mailing Address - Fax:
Practice Address - Street 1:659 ATWOOD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3710
Practice Address - Country:US
Practice Address - Phone:215-327-1925
Practice Address - Fax:215-528-5687
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103597254-001Medicaid