Provider Demographics
NPI:1538225446
Name:TAYLOR, KATHERINE LORING (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LORING
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 180680
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018
Mailing Address - Country:US
Mailing Address - Phone:262-646-6280
Mailing Address - Fax:262-646-6284
Practice Address - Street 1:2500 GRANT ROAD
Practice Address - Street 2:ECH 133 BEHAVIORAL HEALTH
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-988-7626
Practice Address - Fax:650-988-7825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA842052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A842050Medicaid
CA00A842052Medicare PIN
CA00A842050Medicaid
CA00A842051Medicare PIN