Healthcare Provider Details

I. General information

NPI: 1851589881
Provider Name (Legal Business Name): MICHAEL WILLIAM TAYLOR RT(R)(CV)(CI)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MAIN ST
MILLBURY MA
01527-2036
US

IV. Provider business mailing address

135 MAIN ST
MILLBURY MA
01527-2036
US

V. Phone/Fax

Practice location:
  • Phone: 508-612-3252
  • Fax:
Mailing address:
  • Phone: 508-612-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C1106X
TaxonomyCardiac-Interventional Technology Radiologic Technologist
License Number07404
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: