Provider Demographics
NPI:1356580534
Name:TAYLAN, JOHN BRYAN M
Entity type:Individual
Prefix:MR
First Name:JOHN BRYAN
Middle Name:M
Last Name:TAYLAN
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 1:1573 PROVINCIAL LN STE 102
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1640
Mailing Address - Country:US
Mailing Address - Phone:757-240-6529
Mailing Address - Fax:
Practice Address - Street 1:1573 PROVINCIAL LN
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1640
Practice Address - Country:US
Practice Address - Phone:757-240-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22758171W00000X
IN05009782A171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor