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 | 207QA0505X | Family Medicine | Adult Medicine | 5 | WEST VIRGINIA | No |
| 2 | 207R00000X | Internal Medicine | | 5 | WEST VIRGINIA | No |
| 3 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | 5 | WEST VIRGINIA | No |
| 4 | 207RG0100X | Internal Medicine | Gastroenterology | 5 | WEST VIRGINIA | No |
| 5 | 207RH0003X | Internal Medicine | Hematology & Oncology | 5 | WEST VIRGINIA | No |
| 6 | 207RI0200X | Internal Medicine | Infectious Disease | 5 | WEST VIRGINIA | No |
| 7 | 207V00000X | Obstetrics & Gynecology | | 5 | WEST VIRGINIA | No |
| 8 | 207X00000X | Orthopaedic Surgery | | 5 | WEST VIRGINIA | No |
| 9 | 207ZC0500X | Pathology | Cytopathology | 5 | WEST VIRGINIA | No |
| 10 | 207ZP0102X | Pathology | Anatomic Pathology & Clinical Pathology | 5 | WEST VIRGINIA | No |
| 11 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 5 | WEST VIRGINIA | No |
| 12 | 2084P0800X | Psychiatry & Neurology | Psychiatry | 5 | WEST VIRGINIA | No |
| 13 | 208VP0000X | Pain Medicine | Pain Medicine | 5 | WEST VIRGINIA | No |
| 14 | 207QA0000X | Family Medicine | Adolescent Medicine | 5 | WEST 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 | 9325721 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | |
