Provider Demographics
NPI:1104898352
Name:TAYLOR, ALAN R (PA-C)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 CHESTER PIKE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1375
Mailing Address - Country:US
Mailing Address - Phone:610-521-6063
Mailing Address - Fax:610-521-0163
Practice Address - Street 1:1510 CHESTER PIKE
Practice Address - Street 2:SUITE 130
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1375
Practice Address - Country:US
Practice Address - Phone:610-521-6063
Practice Address - Fax:610-521-0163
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051310363AM0700X, 363AS0400X, 364SH0200X
NJ25MP00106500363A00000X
FLPA9103970363AM0700X
DEC5-0000804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ575ZMedicare UPIN
PA064633N0NMedicare PIN
NJ080485WJ8Medicare PIN
PAP73079Medicare UPIN
PAMA051310Medicare PIN
DE235050ZCB4Medicare PIN
PA230593P4RMedicare PIN