MEDICARE: DR. GARY L TAYLOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	53555	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0401251	OTHER	MA	UNITED HEALTHCARE
2	J05571	OTHER		BLUE CROSS/BLUE SHIELD
3	000000020228	OTHER	MA	BOSTON HEALTH NET
4	709833	OTHER		TUFTS ASSOCIATED HEALTH P
5	92477	OTHER		AETNA US HEALTHCARE
6	B10127801	OTHER		CIGNA HEALTHCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952390007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L TAYLOR M.D.

Provider Business Mailing Address
First Line	:	69 WILMINGTON AVE
Second Line	:
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-4512
Country	:	US
Telephone Number	:	617-436-8968
Fax Number	:

Provider Business Practice Location Address
First Line	:	2110 DORCHESTER AVE
Second Line	:	SUITE 311
City	:	DORCHESTER CENTER
State	:	MA
Zip	:	02124-5628
Country	:	US
Telephone Number	:	617-296-0456
Fax Number	:	617-296-1655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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