Provider Demographics
NPI:1366419350
Name:TAYLOR, TAMMY J (DO)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 LOONEY RD
Mailing Address - Street 2:101
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-4199
Mailing Address - Country:US
Mailing Address - Phone:937-440-8687
Mailing Address - Fax:937-773-8058
Practice Address - Street 1:280 LOONEY RD
Practice Address - Street 2:101
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4199
Practice Address - Country:US
Practice Address - Phone:937-440-8687
Practice Address - Fax:937-773-8058
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2424013Medicaid
12015Medicare UPIN
OH2424013Medicaid
OH4138821Medicare PIN
OH4138822Medicare PIN
OH4138823Medicare PIN