Provider Demographics
NPI:1396778544
Name:TAYLOR, AMY MARLINDA (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARLINDA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:MARLINDA
Other - Last Name:FAJARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:549 FAIR STREET
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2204
Practice Address - Country:US
Practice Address - Phone:570-387-2111
Practice Address - Fax:570-387-2245
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057161A207P00000X
PAMD420942207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101426964Medicaid
PA075249Medicare ID - Type Unspecified
PAH97978Medicare UPIN