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General NPI Number Information
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NPI Number | 1083040117
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Entity Type | Individual
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Provider Name | JONATHAN L TAYLOR PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 110 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-3017
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Country | US
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Telephone | 202-877-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 RHODE ISLAND AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20005-4416
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Country | US
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Telephone | 440-328-6239
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.003868
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA031175
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License Number State | DC
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