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NPI Code Detail

MEDICARE: STEPHEN ANDREW TAYLOR AT

MEDICARE:   STEPHEN ANDREW TAYLOR  AT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2000007101OH

General Provider Information

NPI Number : 1053964148
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN ANDREW TAYLOR AT
Provider Business Mailing Address
First Line : 625 E MONROE AVE APT 210
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22301-3023
Country : US
Telephone Number : 727-735-7123
Fax Number :
Provider Business Practice Location Address
First Line : 4665 BLUE PLAINS DR SW
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-5202
Country : US
Telephone Number : 202-645-6669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2019
Last Update Date : 07/18/2019

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Directions to “ STEPHEN ANDREW TAYLOR AT” Practice Location

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