Provider Demographics
NPI:1124175047
Name:TAYLOR, WILLIAM COLTON (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COLTON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:COLTON
Other - Last Name:LANDAU-TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:HEALTHCARE ASSOCIATES, BETH ISRAEL DEACONESS MED CTR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-9600
Mailing Address - Fax:617-667-8665
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:HEALTHCARE ASSOCIATES, BETH ISRAEL DEACONESS MED CTR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-9600
Practice Address - Fax:617-667-8665
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2054744Medicaid
MAB72994Medicare UPIN