Provider Demographics
NPI:1427093558
Name:TAYLOR, RONDALPH SAMUEL JR (MD)
Entity type:Individual
Prefix:
First Name:RONDALPH
Middle Name:SAMUEL
Last Name:TAYLOR
Suffix:JR
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 1:36 SAINT JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3206
Mailing Address - Country:US
Mailing Address - Phone:678-381-6170
Mailing Address - Fax:718-228-6919
Practice Address - Street 1:36 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3206
Practice Address - Country:US
Practice Address - Phone:678-381-6170
Practice Address - Fax:718-228-6919
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057504207P00000X
NJ25MA10166800207P00000X
NY229432207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA255118688AMedicaid
GA255118688BMedicaid
GA93BFCMKMedicare PIN
GAI58167Medicare UPIN