MEDICARE: DR. ELLEN B. TAUPIN 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	103T00000X	Psychologist	PS004864L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0108853000	OTHER	PA	IND BLUE CROSS PROVIDER #
2	TA500684	OTHER	PA	HIGHMARK BLUE SHIELD PROV

General Provider Information

NPI Number	:	1669543187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN B. TAUPIN PH.D.

Provider Business Mailing Address
First Line	:	25 WASHINGTON LN STE 8A
Second Line	:
City	:	WYNCOTE
State	:	PA
Zip	:	19095-1400
Country	:	US
Telephone Number	:	215-830-9841
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 WASHINGTON LN STE 8A
Second Line	:
City	:	WYNCOTE
State	:	PA
Zip	:	19095-1400
Country	:	US
Telephone Number	:	215-830-9841
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	11/20/2022

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