Provider Demographics
NPI:1952390007
Name:TAYLOR, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:69 WILMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-4512
Mailing Address - Country:US
Mailing Address - Phone:617-436-8968
Mailing Address - Fax:
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-296-0456
Practice Address - Fax:617-296-1655
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA53555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0401251OtherUNITED HEALTHCARE
J05571OtherBLUE CROSS/BLUE SHIELD
MA000000020228OtherBOSTON HEALTH NET
709833OtherTUFTS ASSOCIATED HEALTH P
92477OtherAETNA US HEALTHCARE
B10127801OtherCIGNA HEALTHCARE
MA3037444Medicaid
MA0401251OtherUNITED HEALTHCARE
J05571OtherBLUE CROSS/BLUE SHIELD