Healthcare Provider Details

I. General information

NPI: 1801042692
Provider Name (Legal Business Name): KIMA JOY TAYLOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

IV. Provider business mailing address

3501 SINCLAIR LN
BALTIMORE MD
21213-2029
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-4888
  • Fax: 410-327-1693
Mailing address:
  • Phone: 410-558-4888
  • Fax: 410-327-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD64427
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD30996
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: