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 | 2085B0100X | Radiology | Body Imaging | 200201171 | NORTH CAROLINA | No |
| 2 | 2085N0700X | Radiology | Neuroradiology | 200201171 | NORTH CAROLINA | No |
| 3 | 2085N0904X | Radiology | Nuclear Radiology | 200201171 | NORTH CAROLINA | No |
| 4 | 2085P0229X | Radiology | Pediatric Radiology | 200201171 | NORTH CAROLINA | No |
| 5 | 2085R0202X | Radiology | Diagnostic Radiology | 200201171 | NORTH CAROLINA | Yes |
| 6 | 2085R0203X | Radiology | Therapeutic Radiology | 200201171 | NORTH CAROLINA | No |
| 7 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 200201171 | NORTH CAROLINA | No |
| 8 | 2085R0205X | Radiology | Radiological Physics | 200201171 | NORTH CAROLINA | No |
| 9 | 2085U0001X | Radiology | Diagnostic Ultrasound | 200201171 | NORTH CAROLINA | No |
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 | 132H4 | OTHER | NORTH CAROLINA | BCBS |
| 2 | 560941927 | OTHER | NORTH CAROLINA | CIGNA |
| 3 | 2009517 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | |
| 4 | 89132H4 | MEDICAID | NORTH CAROLINA | |
| 5 | P00067355 | OTHER | NORTH CAROLINA | RAILROAD MEDICARE |
| 6 | 246190 | OTHER | NORTH CAROLINA | MAMSI |
| 7 | B00123 | MEDICARE UPIN | NORTH CAROLINA | |
| 8 | 560941927 | OTHER | NORTH CAROLINA | MEDCOST |
| 9 | 560941927 | OTHER | NORTH CAROLINA | UNITED HEALTHCARE |
