Provider Demographics
NPI:1205800158
Name:TAYLOR, JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
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 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-425-5446
Mailing Address - Fax:508-425-5951
Practice Address - Street 1:385 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2498
Practice Address - Country:US
Practice Address - Phone:508-425-5446
Practice Address - Fax:508-425-5951
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155015207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110059806AMedicaid
2900627OtherEVERCARE
43864OtherCHILDRENS MEDICAL SECURIT
AA2314OtherHARVARD PILGRIM HEALTHCAR
J18197OtherBLUE SHIELD INDEMNITY
2030229OtherFIRST HEALTH
MA3179842Medicaid
784096OtherMVP HEALTH CARE
3179842OtherMEDICAID WELFARE
37850OtherFALLON COMMUNITY HEALTH P
7457928OtherCIGNA HEALTH PLAN
J18197OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
100016974OtherRAILROAD MEDICARE
J18197OtherBLUE CARE ELECT
43864OtherHEALTHY START
5113580OtherAETNA US HEALTHCARE
A28683OtherMEDICARE B
MA3179842Medicaid
7457928OtherCIGNA HEALTH PLAN