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 | 207ZC0500X | Pathology | Cytopathology | 0101222257 | VIRGINIA | No |
| 2 | 207ZP0102X | Pathology | Anatomic Pathology & Clinical Pathology | 0101222257 | 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 | 94046 | OTHER | NEW YORK | BLUE CROSS BLUE SHIELD |
| 2 | 006604811 | MEDICAID | VIRGINIA | |
| 3 | 028799100 | MEDICAID | DISTRICT OF COLUMBIA | |
| 4 | 16699 | OTHER | | GEORGE WASHINGTON UNIV |
| 5 | 96-246-5316 | OTHER | DISTRICT OF COLUMBIA | WORKERS COMP DC |
| 6 | 220028329 | OTHER | | RAILROAD MEDICARE |
| 7 | Q22257 | MEDICAID | SOUTH CAROLINA | |
| 8 | 004797J66 | MEDICARE PIN | VIRGINIA | |
| 9 | 1022-0005 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BLUE CROSS BS |
| 10 | 1305167 | OTHER | | UNITED MINE WORKERS |
| 11 | 279438 | OTHER | | OPTIMUM CHOICE |
| 12 | G71296 | MEDICARE UPIN | | |
| 13 | 11-00277 | OTHER | | UNITED HEALTHCARE |
| 14 | 279438 | OTHER | | MAMSI |
| 15 | 451401 | OTHER | VIRGINIA | ANTHEM BLUE CROSS BS |
| 16 | 506848 | OTHER | | NATIONAL CAPITAL PPO |
| 17 | 279438 | OTHER | | MDIPA |
| 18 | 490050CG71296 | OTHER | VIRGINIA | SECTION 1011 MEDICARE |