Provider Demographics
NPI:1306065446
Name:ORTIZ, TAYLOR M (MD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRANCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1979
Mailing Address - Country:US
Mailing Address - Phone:978-620-2020
Mailing Address - Fax:978-620-2299
Practice Address - Street 1:5 BRANCH ST STE 100
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1979
Practice Address - Country:US
Practice Address - Phone:978-620-2020
Practice Address - Fax:978-620-2299
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231849207RX0202X
IN01076200A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1306065446Medicaid
NH3076118Medicaid
NHP00918387OtherRR MEDICARE
ME1306065446Medicaid