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General NPI Number Information
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NPI Number | 1205800158
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Entity Type | Individual
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Provider Name | JONATHAN TAYLOR MD
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 385 SOUTHBRIDGE ST
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City | AUBURN
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State | MA
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Zip | 01501-2498
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Country | US
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Telephone | 508-425-5446
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Fax | 508-425-5951
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Provider Business Mailing Address
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Address Line | 5 NEPONSET ST WOT 2ND FL, STE C203
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City | WORCESTER
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State | MA
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Zip | 01606-2714
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Country | US
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Telephone | 508-425-5446
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Fax | 508-425-5951
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 155015
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License Number State | MA
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