Healthcare Provider Details

I. General information

NPI: 1205478963
Provider Name (Legal Business Name): CATHERINE RUTH TAYLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE RUTH SCHROEDER PA-C

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W LEXINGTON ST
BALTIMORE MD
21201-1508
US

IV. Provider business mailing address

3700 TOONE ST APT 2337
BALTIMORE MD
21224-5176
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0007679
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: