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 | 0101035361 | 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 | 0002 | OTHER | | CAREFIRST PROVIDER # |
| 2 | 00V372C96 | OTHER | | MEDICARE OF VA PROVIDER # |
| 3 | 541977219 | OTHER | | ALLIANCE GEHA GROUP # |
| 4 | 57110 | OTHER | | MAMSI PROVIDER # |
| 5 | 432669 | OTHER | | ANTHEM PROVIDER # |
| 6 | 5726 | OTHER | | CAREFIRST GROUP # |
| 7 | 541977219 | OTHER | | UNITED HEALTHCARE PROVIDE |
| 8 | 000X99C88 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | |
| 9 | C08696 | OTHER | | MEDICARE OF VA GROUP # |
| 10 | 541977219 | OTHER | | MAMSI GROUP # |
| 11 | 541977219 | OTHER | | NALC AFFORDABLE PROVIDER |
| 12 | 541977219 | OTHER | | CIGNA PROVIDER # |
| 13 | 541977219 | OTHER | | MDIPA GROUP # |
| 14 | C61696 | MEDICARE UPIN | | |
| 15 | 259418 | OTHER | | ANTHEM GROUP # |
| 16 | 4427684 | OTHER | | AETNA PPOPOS PROVIDER # |
| 17 | 57110 | OTHER | | MDIPA PROVIDER # |
| 18 | 57110 | OTHER | | ALLIANCE GEHA PROVIDER # |
| 19 | 737485 | OTHER | | AETNA HMO PROVIDER # |
| 20 | 005842344 | MEDICAID | VIRGINIA | |