Provider Demographics
NPI:1144463670
Name:TAYLOR, BEN FRAZIER (MD, PHD)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:FRAZIER
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4403
Mailing Address - Country:US
Mailing Address - Phone:518-926-6670
Mailing Address - Fax:518-926-6672
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4403
Practice Address - Country:US
Practice Address - Phone:518-926-6670
Practice Address - Fax:518-926-6672
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273390-12085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty