=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881704781
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA RENEE TAYLOR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VA MEDICAL CENTER 1400 BLACKHORSE HILL RD
-----------------------------------------------------
City | COATESVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-384-7711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1307 HULNICK RD
-----------------------------------------------------
City | COATESVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19320-2097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 210379
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------