Healthcare Provider Details

I. General information

NPI: 1588236780
Provider Name (Legal Business Name): TAYLOR MARIE GUM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 BOWMANS FARM RD STE 104
FREDERICK MD
21701-3577
US

IV. Provider business mailing address

10129 PELICAN POINT ST
NEW MARKET MD
21774-6976
US

V. Phone/Fax

Practice location:
  • Phone: 410-202-8581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number28530
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: