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 | 207R00000X | Internal Medicine | | 0101264898 | VIRGINIA | No |
| 2 | 207R00000X | Internal Medicine | | 25MA09668800 | NEW JERSEY | No |
| 3 | 207R00000X | Internal Medicine | | ME96603 | FLORIDA | 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 | MD-20583 | OTHER | HAWAII | HAWAII STATE LICENSE |
| 2 | MD462196 | OTHER | PENNSYLVANIA | PENNSYLVANIA STATE LICENSE |
| 3 | 078512 | OTHER | GEORGIA | GEORGIA STATE LICENSE |
| 4 | 2019-01534 | OTHER | NORTH CAROLINA | NORTH CAROLINA STATE LICENSE |
| 5 | 76171 | OTHER | MONTANA | MONTANA STATE LICENSE |
| 6 | 0101264898 | OTHER | VIRGINIA | VIRGINIA STATE LICENSE |
| 7 | 31765 | OTHER | NEBRASKA | NEBRASKA STATE LICENSE |
| 8 | 51762 | OTHER | SOUTH CAROLINA | SOUTH CAROLINA LICENSE |
| 9 | 61402 | OTHER | CONNECTICUT | CONNECTICUT STATE LICENSE |
| 10 | 036145182 | OTHER | ILLINOIS | ILLINOIS STATE LICENSE |
| 11 | 10800188 | OTHER | UTAH | UTAT STATE LICENSE |
| 12 | 57668 | OTHER | TENNESSEE | TENNESSEE |
| 13 | 7206220 | OTHER | WISCONSIN | WISCONSON STATE LICENSE |
| 14 | TL6006 | OTHER | WYOMING | WYOMING STATE LICENSE |
| 15 | MD.43069 | OTHER | ALABAMA | STATE LICENSE |
| 16 | 308192 | OTHER | LOUISIANA | LOUISIANA STATE LICENSE |
| 17 | 04-41271 | OTHER | KANSAS | KANSAS STATE LICENSE |
| 18 | 4301115326 | OTHER | MICHIGAN | MICHIGAN STATE LICENSE |
| 19 | MD60947259 | OTHER | WASHINGTON | WASHINGTON STATE LICENSE |
| 20 | 022203 | OTHER | PUERTO RICO | PUERTO RICO STATE LICENSE |
| 21 | 2019032474 | OTHER | MISSOURI | MISSOURI STATE LICENSE |
| 22 | 25MA09668800 | OTHER | NEW JERSEY | NEW JERSEY STATE LICENSE |
| 23 | 35.136642 | OTHER | OHIO | OHIO STATE LICENSE |
| 24 | C154678 | OTHER | CALIFORNIA | CALIFORNIA STATE LICENSE |
| 25 | DR.0060459 | OTHER | COLORADO | COLORADO STATE LICENSE |
| 26 | R9508 | OTHER | TEXAS | TEXAS STATE LICENSE |
