MEDICARE: CAROL P 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	207Q00000X	Family Medicine Physician	226652	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400062098	OTHER		MEDICARE

General Provider Information

NPI Number	:	1699776294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL P TAYLOR M.D.

Provider Business Mailing Address
First Line	:	2 COATES DR
Second Line	:
City	:	GOSHEN
State	:	NY
Zip	:	10924-6758
Country	:	US
Telephone Number	:	845-651-1400
Fax Number	:	845-651-1512

Provider Business Practice Location Address
First Line	:	21 MAPLE AVE
Second Line	:
City	:	WARWICK
State	:	NY
Zip	:	10990-1026
Country	:	US
Telephone Number	:	845-986-3311
Fax Number	:	845-987-2484

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/11/2012

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