Provider Demographics
NPI:1255972667
Name:TAYLOR, LARRY LEE (AUD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 N CHARLES ST STE 601
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5801
Mailing Address - Country:US
Mailing Address - Phone:410-821-5151
Mailing Address - Fax:410-823-8642
Practice Address - Street 1:6535 N CHARLES ST STE 250
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5829
Practice Address - Country:US
Practice Address - Phone:410-821-5151
Practice Address - Fax:410-823-8642
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01504231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist