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 | 207ZP0102X | Pathology | Anatomic Pathology & Clinical Pathology | 0101-029766 | 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 | 490050CC62678 | OTHER | | SECTION 1011 MEDICARE |
| 2 | 339836 | OTHER | | OPTIMUM CHOICE |
| 3 | 339836 | OTHER | | MDIPA |
| 4 | 240523 | OTHER | VIRGINIA | ANTHEM BLUE CROSS BS |
| 5 | C62678 | MEDICARE UPIN | | |
| 6 | 1022-0004 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BLUE CROSS DC |
| 7 | 220017496 | OTHER | | RAILROAD MEDICARE |
| 8 | 16699 | OTHER | | GEORGE WASHINGTON UNIV |
| 9 | 11-00210 | OTHER | | UNITED HEALTHCARE |
| 10 | 879500200 | MEDICAID | MARYLAND | |
| 11 | 96-2465316 | OTHER | DISTRICT OF COLUMBIA | WORKERS COMP DC |
| 12 | 1305167 | OTHER | | UNITED MINE WORKERS |
| 13 | 339836 | OTHER | | MAMSI |
| 14 | 033007700 | MEDICAID | DISTRICT OF COLUMBIA | |
| 15 | 415491 | MEDICARE PIN | VIRGINIA | |
| 16 | 506849 | OTHER | | NATIONAL CAPITAL PPO |
| 17 | 006601782 | MEDICAID | VIRGINIA | |
