Healthcare Provider Details

I. General information

NPI: 1003018813
Provider Name (Legal Business Name): DONALD HARRY TAYLOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 CRAIN HWY SUBSTANCE ABUSE SERVICES
WHITE PLAINS MD
20695-1050
US

IV. Provider business mailing address

10617 SHOOTING STAR LN.
WALDORF MD
20603-5747
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-6600
  • Fax: 301-934-1234
Mailing address:
  • Phone: 301-645-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberH0028450
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberH0028450
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH0028450
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberH0028450
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: