Provider Demographics
NPI:1144221607
Name:TAYLOR, GREGORY WARWICK (MD)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WARWICK
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 1:34 JEROME AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2463
Mailing Address - Country:US
Mailing Address - Phone:860-966-9680
Mailing Address - Fax:860-206-6075
Practice Address - Street 1:34 JEROME AVE STE 204
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:860-966-9680
Practice Address - Fax:860-206-6075
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0460102084N0400X
NY2265022084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02581973Medicaid
I22631Medicare UPIN
NY565N62Medicare ID - Type Unspecified
NY02581973Medicaid