Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 207RA0401X | Internal Medicine | Addiction Medicine | D0084292 | MARYLAND | No |
| 2 | 261Q00000X | Clinic/Center | | MD 038372 | DISTRICT OF COLUMBIA | No |
| 3 | 207RA0401X | Internal Medicine | Addiction Medicine | 0101262019 | VIRGINIA | No |
| 4 | 332B00000X | Durable Medical Equipment & Medical Supplies | | MD038372 | DISTRICT OF COLUMBIA | No |
| 5 | 208D00000X | General Practice | | 0101262019 | VIRGINIA | Yes |
| 6 | 208D00000X | General Practice | | MD038372 | DISTRICT OF COLUMBIA | No |
| 7 | 261Q00000X | Clinic/Center | | MD430487 | PENNSYLVANIA | No |
| 8 | 261QU0200X | Clinic/Center | Urgent Care | MD 038372 | DISTRICT OF COLUMBIA | No |
| 9 | 208D00000X | General Practice | | C1-0008405 | DELAWARE | No |
| 10 | 207RA0401X | Internal Medicine | Addiction Medicine | MD038372 | DISTRICT OF COLUMBIA | No |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 040597500 | MEDICAID | DISTRICT OF COLUMBIA | |
