Provider Demographics
NPI:1417923038
Name:TAYLOR, BRADLEY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SCOTT
Last Name:TAYLOR
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 1:306 W REDWOOD ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1708
Mailing Address - Country:US
Mailing Address - Phone:667-214-1720
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5842
Practice Address - Fax:410-328-2750
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057315L208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD037221800Medicaid
PA001897366Medicaid
PA413356OtherHIGHMARK BLUE SHIELD
PA73738OtherGEISINGER
PA210465OtherJOHNS HOPKINS
PA7851406OtherAETNA
PA058368FLTMedicare PIN
PAH62012Medicare UPIN
MD037221800Medicaid