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 | 207R00000X | Internal Medicine | | D0020516 | MARYLAND | 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 | 4053614 | OTHER | MARYLAND | AETNA PPO PROVIDER NUMBER |
| 2 | 8126842 | OTHER | MARYLAND | OPTIMUM CHOICE PROV # |
| 3 | 080944P78 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | |
| 4 | 8126842 | OTHER | MARYLAND | ALLIANCE PROVIDER NUMBER |
| 5 | C61782 | MEDICARE UPIN | MARYLAND | |
| 6 | 4053614 | OTHER | MARYLAND | AETNA HMO PROVIDER NUMBER |
| 7 | 8126842 | OTHER | MARYLAND | MAMSI PROVIDER NUMBER |
| 8 | 8126842 | OTHER | MARYLAND | MDIPA PROVIDER NUMBER |
| 9 | 42057604 | OTHER | MARYLAND | BSMD PROVIDER NUMBER |
| 10 | P00330525 | OTHER | | MEDICARE RAILROAD |
| 11 | 9070 0003 | OTHER | MARYLAND | BSDC PROVIDER NUMBER |
| 12 | 026541 | OTHER | MARYLAND | JHHC PROVIDER NUMBER |
| 13 | 0905926 | OTHER | MARYLAND | CIGNA PROVIDER NUMBER |
| 14 | 521186611 | OTHER | MARYLAND | UNITED HEALTHCARE PROV # |
