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 | 207RH0002X | Internal Medicine | Hospice and Palliative Medicine | MD048473L | PENNSYLVANIA | No |
| 2 | 208000000X | Pediatrics | | MD048473L | PENNSYLVANIA | No |
| 3 | 207R00000X | Internal Medicine | | MD048473L | PENNSYLVANIA | 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 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
| 2 | 4344547 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
| 3 | 734976 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 4 | G920-0023/527593 | OTHER | PENNSYLVANIA | CAREFIRST |
| 5 | 25-1716306 | OTHER | PENNSYLVANIA | MULTIPLAN/PHCS |
| 6 | 3740283 | OTHER | PENNSYLVANIA | AETNA HMO |
| 7 | 50060239 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS |
| 8 | MD048473L | OTHER | PENNSYLVANIA | LICENSE |
| 9 | P006158 | OTHER | PENNSYLVANIA | GATEWAY |
| 10 | 25-1716306 | OTHER | PENNSYLVANIA | GREATWEST |
| 11 | 867633 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
| 12 | 1334507 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 13 | 2131772 | OTHER | PENNSYLVANIA | MAMSI |
| 14 | 25-1716306 | OTHER | PENNSYLVANIA | INFORMED |
| 15 | P00209078 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 16 | 001408560 0004 | MEDICAID | PENNSYLVANIA | |
| 17 | 120420407 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
| 18 | 193562 | OTHER | PENNSYLVANIA | UNISON (HFC) |
| 19 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
| 20 | 25-1716306 | OTHER | PENNSYLVANIA | SOUTH CENTRAL PREFERRED |
| 21 | 280083 | OTHER | PENNSYLVANIA | UNISON (GI) |
| 22 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |
| 23 | 441392 | OTHER | PENNSYLVANIA | HEALTH AMERICA |