Provider Demographics
NPI:1053369017
Name:YATES, HAROLD TAYLOR JR (MD)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:TAYLOR
Last Name:YATES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:91 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-2209
Mailing Address - Country:US
Mailing Address - Phone:802-524-6746
Mailing Address - Fax:802-524-4421
Practice Address - Street 1:91 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2209
Practice Address - Country:US
Practice Address - Phone:802-524-6746
Practice Address - Fax:802-524-4421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT04200057132080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004642Medicaid