{
"Npi": {
"NPI": "1861073702",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BLACKWELL",
"FirstName": "TAYLOR",
"MiddleName": "KAI",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PETER-BIBB",
"OtherFirstName": "TAYLOR",
"OtherMiddleName": "KAI",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3528 BEECH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21211-2641",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-218-0770",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2150 PENNSYLVANIA AVE NW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WASHINGTON",
"PracticeLocationAddressStateName": "DC",
"PracticeLocationAddressPostalCode": "20037-3201",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "202-741-3000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/20/2021",
"LastUpdateDate": "07/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207P00000X",
"TaxonomyName": "Emergency Medicine Physician",
"LicenseNumber": "D0102896",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}