Provider Demographics
NPI:1386604759
Name:TAYLOR KELLY, LISA M (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TAYLOR KELLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:WOT FL 12 ATTN: PHYSICIAN SERVICES
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:508-368-5530
Practice Address - Street 1:35 MILLBURY ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501
Practice Address - Country:US
Practice Address - Phone:508-832-5917
Practice Address - Fax:508-832-5751
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA158182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
33744OtherFALLON COMMUNITY HEALTH P
2039829OtherFIRST HEALTH
3190099OtherMEDICAID WELFARE
J19335OtherBLUE SHIELD INDEMNITY
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherTHREE RIVERS
MA3190099Medicaid
J19335OtherBLUE SHIELD HMO BLUE
7166020OtherAETNA US HEALTHCARE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
34378OtherHEALTHY START
34378OtherCHILDRENS MEDICAL SECURIT
3523062OtherCIGNA HEALTH PLAN
J19335OtherBLUE CARE ELECT
784202OtherMVP HEALTH CARE
A28596OtherMEDICARE B
AA1182OtherHARVARD PILGRIM HEALTH CA