Healthcare Provider Details

I. General information

NPI: 1629303581
Provider Name (Legal Business Name): TAYLOR MEDICAL ASSOCIATES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2009
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N MAIN ST
TAYLOR PA
18517-1415
US

IV. Provider business mailing address

3 W OLIVE ST SUITE 201
SCRANTON PA
18508-2572
US

V. Phone/Fax

Practice location:
  • Phone: 570-562-0421
  • Fax: 570-986-0005
Mailing address:
  • Phone: 570-969-0663
  • Fax: 570-969-9697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013728
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOS013728
License Number StatePA

VIII. Authorized Official

Name: DR. GLENN MICHAEL BUYO
Title or Position: FAMILY PHYSICIAN
Credential: D.O.
Phone: 570-562-0421