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General NPI Number Information
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NPI Number | 1295465714
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Entity Type | Organization
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Legal Business Name | TAYLORED UROGYN CARE
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 2164 NOTTOWAY DRIVE
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City | HANOVER
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State | MD
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Zip | 21076-1095
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Country | US
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Telephone | 667-274-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 2657G ANNAPOLIS RD # 327
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City | HANOVER
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State | MD
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Zip | 21076-1262
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Country | US
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Telephone | 667-274-3333
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Fax |
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Authorized Official
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Title or Position | UROGYNECOLOGIC SPECIALIST
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Name | DR. AISHA KHALALI TAYLOR
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Credential | MD
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Telephone | 312-450-4883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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