Individual
DR. CHARLES RUSSELL TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 STANIFORD ST STE 200, BOSTON, MA 02114-2543
(617) 726-2914
(617) 726-7768
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-2914
(617) 726-7768
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
60034
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060034
TUFTS HEALTH PLAN
MA
05
—
3119211
—
MA
01
—
J14447
BCBS MA
MA
Enumeration date
10/28/2005
Last updated
06/03/2021
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