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 | 207LP2900X | Anesthesiology | Pain Medicine | MD422419 | PENNSYLVANIA | Yes |
| 2 | 207L00000X | Anesthesiology | | MD422419 | PENNSYLVANIA | 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 | 1569284 | OTHER | PENNSYLVANIA | GATEWAY |
| 2 | 2154658 | OTHER | PENNSYLVANIA | MAMSI |
| 3 | 50083161 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS (PMFC) |
| 4 | 922049-04 | OTHER | PENNSYLVANIA | CAREFIRST MD (PMFC) |
| 5 | 1511160 | OTHER | PENNSYLVANIA | HIGHMARK BLUESHIELD |
| 6 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
| 7 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |
| 8 | P00458429 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 9 | 050514 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
| 10 | 1763477 | OTHER | PENNSYLVANIA | AETNA HMO (AFC) |
| 11 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
| 12 | 25-1716306 | OTHER | PENNSYLVANIA | INFORMED |
| 13 | 25-1716306 | OTHER | PENNSYLVANIA | MULTIPLAN/PHCS |
| 14 | 100816820 0003 | MEDICAID | PENNSYLVANIA | |
| 15 | 25-1716306 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 16 | PEARL PROVIDER | OTHER | PENNSYLVANIA | HEALTH AMERICA |
| 17 | 227939 | OTHER | PENNSYLVANIA | UNISON (AFC) |
| 18 | 50073146 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS (AFC) |
| 19 | 7741677 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
| 20 | 1007307260037 | OTHER | PENNSYLVANIA | MEDICAID GROUP # (PMFC) |
| 21 | 100816820 0001 | MEDICAID | PENNSYLVANIA | |
| 22 | 289723 | OTHER | PENNSYLVANIA | UNISON (PMFC) |
| 23 | MD422419 | OTHER | PENNSYLVANIA | LICENSE |
| 24 | 100816820 0002 | MEDICAID | PENNSYLVANIA | |
| 25 | 25-1716306 | OTHER | PENNSYLVANIA | SOUTH CENTRAL PREFERRED |
| 26 | V132-0001 | OTHER | PENNSYLVANIA | CAREFIRST DC (PMFC) |
| 27 | 1007307260036 | OTHER | PENNSYLVANIA | MEDICAID GROUP # (AFC) |
| 28 | 120420418 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
| 29 | 6802723 | OTHER | PENNSYLVANIA | AETNA HMO (PMFC) |