MEDICARE: MADYSEN TAYLOR ACRA PA-C

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	363A00000X	Physician Assistant	50.008934RX	OH

General Provider Information

NPI Number	:	1982412383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADYSEN TAYLOR ACRA PA-C

Provider Business Mailing Address
First Line	:	8701 OLD TROY PIKE STE 240
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1053
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8701 OLD TROY PIKE STE 240
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-1053
Country	:	US
Telephone Number	:	937-396-2880
Fax Number	:

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

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	02/27/2025

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