Healthcare Provider Details

I. General information

NPI: 1376462507
Provider Name (Legal Business Name): MADISON TAYLOR BLOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 ROUTE 9 STE 204
HALFMOON NY
12065-2466
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-9355
  • Fax: 518-373-9139
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: