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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 20934 | WEST VIRGINIA | No |
| 2 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 0101048188 | VIRGINIA | Yes |
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 | 550941600 | OTHER | MARYLAND | MD MEDICAID GRP IN VA |
| 2 | 9332051 | OTHER | WEST VIRGINIA | WV MEDICARE GRP OLD |
| 3 | 0086502000 | MEDICAID | WEST VIRGINIA | |
| 4 | 08251100000 | OTHER | | QUALCHOICE |
| 5 | 2119629 | OTHER | | MAMSI PROFESSIONAL |
| 6 | 000486018 | OTHER | | WV BLUE SHIELD |
| 7 | 9371521 | OTHER | WEST VIRGINIA | WV MEDICARE B - GROUP # |
| 8 | C00085 | OTHER | | VA MEDICARE B - GROUP # |
| 9 | 000875693 | OTHER | | WV BLUE SHIELD - GROUP # |
| 10 | 211032 | OTHER | | ANTHEM PROFESSIONAL |
| 11 | 9332051 | OTHER | WEST VIRGINIA | WV MEDICARE B - GROUP # |
| 12 | 43935 | OTHER | | SENTARA PROFESSIONAL |
| 13 | P00656327 | OTHER | | RAILROAD MEDICARE |
| 14 | 3810003817 | OTHER | WEST VIRGINIA | WV MEDICAID GROUP |
| 15 | 006051120 | MEDICAID | VIRGINIA | |
| 16 | 9371521 | OTHER | WEST VIRGINIA | WV MEDICARE GRP NEW |