Provider Demographics
NPI:1114408291
Name:TAYLOR, GREGORY (EDUCATOR)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN STE 206
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5350
Mailing Address - Country:US
Mailing Address - Phone:240-462-7983
Mailing Address - Fax:301-966-7529
Practice Address - Street 1:1400 MERCANTILE LN STE 206
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5350
Practice Address - Country:US
Practice Address - Phone:240-462-7983
Practice Address - Fax:301-966-7529
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
MD174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator