MEDICARE: DR. MARK A. TAYLOR PH.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	103TC1900X	Counseling Psychologist	1328	AL

General Provider Information

NPI Number	:	1457345720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A. TAYLOR PH.D.

Provider Business Mailing Address
First Line	:	PSC 80 BOX 12188
Second Line	:
City	:	APO
State	:	AP
Zip	:	96367
Country	:	US
Telephone Number	:	315-634-9444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	03/07/2024

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