Individual
JENNIFER TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
130 DIVISION ST, DERBY, CT 06418-1326
(203) 732-1257
Mailing address
67 MAPLE AVE, DERBY, CT 06418-1328
(203) 732-1256
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
304193
LA
207RC0000X
Cardiovascular Disease Physician
Primary
54461
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02673751
—
MS
05
—
2435264
—
LA
Enumeration date
06/13/2012
Last updated
04/29/2021
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