Healthcare Provider Details

I. General information

NPI: 1366518565
Provider Name (Legal Business Name): JOVONSIA M TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W ROLLING XRDS STE 100
CATONSVILLE MD
21228-6277
US

IV. Provider business mailing address

4 W ROLLING XRDS STE 100
CATONSVILLE MD
21228-6277
US

V. Phone/Fax

Practice location:
  • Phone: 410-869-0100
  • Fax: 410-601-7317
Mailing address:
  • Phone: 410-869-0100
  • Fax: 410-601-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD32561
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD56744
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: