Basic Information
Provider Information
NPI: 1003018813
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: DONALD
MiddleName: HARRY
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10617 SHOOTING STAR LN.
Address2:  
City: WALDORF
State: MD
PostalCode: 206035747
CountryCode: US
TelephoneNumber: 3016457352
FaxNumber:  
Practice Location
Address1: 4545 CRAIN HWY
Address2: SUBSTANCE ABUSE SERVICES
City: WHITE PLAINS
State: MD
PostalCode: 206951050
CountryCode: US
TelephoneNumber: 3016096600
FaxNumber: 3019341234
Other Information
ProviderEnumerationDate: 06/04/2007
LastUpdateDate: 02/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084A0401XH0028450MDY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
2084F0202XH0028450MDN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
2084P0800XH0028450MDN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0805XH0028450MDN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry

ID Information
IDTypeStateIssuerDescription
48110620005MD MEDICAID
010882M2501MDPROVIDEROTHER


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