Provider Demographics
NPI:1821037680
Name:TAYLOR, LAUREN M (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:SENTINEL HEALTH PARTNERS PA BUSINESS OFFICE
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021-1259
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:1344 HAILE ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3076
Practice Address - Country:US
Practice Address - Phone:803-432-1996
Practice Address - Fax:803-424-2703
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC848363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
D0354OtherMEDCOST PIN
SC093641Medicaid
SCP00077439OtherRAILROAD MEDICARE PIN
SC093641Medicaid
D0354OtherMEDCOST PIN