Healthcare Provider Details

I. General information

NPI: 1336183003
Provider Name (Legal Business Name): CAROLYN LOUISE TAYLOR-OLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BELMONT AVE
BRATTLEBORO VT
05301-7601
US

IV. Provider business mailing address

2124 PACKER CORNERS RD
GUILFORD VT
05301
US

V. Phone/Fax

Practice location:
  • Phone: 802-442-8164
  • Fax:
Mailing address:
  • Phone: 802-254-9255
  • Fax: 802-254-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42-0007969
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG42258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: