Healthcare Provider Details

I. General information

NPI: 1114695004
Provider Name (Legal Business Name): DABINGTON TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7555 WATERLOO RD
JESSUP MD
20794-9783
US

IV. Provider business mailing address

9102 BEALLS FAM ROAD
FREDERICK MD
21704
US

V. Phone/Fax

Practice location:
  • Phone: 410-799-3400
  • Fax:
Mailing address:
  • Phone: 301-801-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR192553
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: