Provider Demographics
NPI:1831394626
Name:TAYLOR, MARK A (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:TAYLOR
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:300 HANOVER STREET
Practice Address - Street 2:SUITE 2A
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5451
Practice Address - Country:US
Practice Address - Phone:508-679-7774
Practice Address - Fax:508-679-7724
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-01-07
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Provider Licenses
StateLicense IDTaxonomies
MA1455363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATA AP2244Medicare ID - Type Unspecified