MEDICARE: DR. MICHELLE RENEE TAYLOR M.D.

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	207V00000X	Obstetrics & Gynecology Physician	044278	CT

General Provider Information

NPI Number	:	1427075092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE RENEE TAYLOR M.D.

Provider Business Mailing Address
First Line	:	863 N MAIN STREET EXT STE 301
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2434
Country	:	US
Telephone Number	:	203-269-0885
Fax Number	:	203-269-3496

Provider Business Practice Location Address
First Line	:	863 N MAIN STREET EXT STE 301
Second Line	:
City	:	WALLINGFORD
State	:	CT
Zip	:	06492-2434
Country	:	US
Telephone Number	:	203-269-0885
Fax Number	:	203-269-3496

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	10/18/2018

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