MEDICARE: CHARLES D TAYLOR MD

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
1	207RH0003X	Hematology & Oncology Physician	41161	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104815190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES D TAYLOR MD

Provider Business Mailing Address
First Line	:	1493 CAMBRIDGE ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1047
Country	:	US
Telephone Number	:	617-665-1552
Fax Number	:	617-665-1925

Provider Business Practice Location Address
First Line	:	1493 CAMBRIDGE ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-1047
Country	:	US
Telephone Number	:	617-665-1552
Fax Number	:	617-665-1925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/07/2011

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