MEDICARE: TIMOTHY N TAYLOR DO

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	207RP1001X	Pulmonary Disease Physician	34003215T	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA4511	OTHER		RR MEDICARE GROUP
3	290015145	OTHER		RR MEDICARE INDIVIDUAL
6	3610861	OTHER		GROUP ASC MEDICARE
9	9273172	OTHER		GROUP MEDICARE
11	9287148	OTHER	OH	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1780634279	OTHER	GROUP NPI
4	112730	OTHER	KAISER
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	D368301	OTHER	GROUP IND DIAGNOSTICS
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	10800279	OTHER	CAQH

General Provider Information

NPI Number	:	1851368914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY N TAYLOR DO

Provider Business Mailing Address
First Line	:	PO BOX 932085
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0007
Country	:	US
Telephone Number	:	216-267-5139
Fax Number	:	216-267-5133

Provider Business Practice Location Address
First Line	:	18660 BAGLEY RD STE 405
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3483
Country	:	US
Telephone Number	:	440-826-3030
Fax Number	:	440-826-1235

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	01/06/2021

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Directions to “ TIMOTHY N TAYLOR DO” Practice Location

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