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 | C2-0006925 | DELAWARE | No |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | 25MB07488400 | NEW JERSEY | No |
| 3 | 207LP2900X | Anesthesiology | Pain Medicine | OS-010397-L | PENNSYLVANIA | 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 | 0450856000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 2 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 3 | 50052988 | OTHER | PENNSYLVANIA | CAPTIAL BLUE CROSS |
| 4 | 22-1994560 | OTHER | PENNSYLVANIA | FIRST MCO |
| 5 | 3801629 | OTHER | PENNSYLVANIA | AETNA |
| 6 | 751462 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 7 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 8 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 9 | 30027053 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 10 | H04453 | MEDICARE UPIN | PENNSYLVANIA | |
| 11 | 031568GDN | MEDICARE PIN | PENNSYLVANIA | |
| 12 | 8077883 | OTHER | PENNSYLVANIA | CIGNA |
| 13 | 0450856000 | OTHER | PENNSYLVANIA | AMERIHEALTH AND KHPE |
| 14 | 1144269366 | OTHER | PENNSYLVANIA | BRAVO |
| 15 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 16 | 031568D09 | MEDICARE PIN | PENNSYLVANIA | |
| 17 | 184363GDN | MEDICARE PIN | PENNSYLVANIA | |
| 18 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 19 | 080390RUZ | MEDICARE PIN | NEW JERSEY | |
| 20 | 031568S8T | MEDICARE PIN | PENNSYLVANIA | |
| 21 | 031568Q1R | MEDICARE PIN | PENNSYLVANIA | |
| 22 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 23 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 24 | 23-2919275 | OTHER | NEW JERSEY | FIRST MCO |
| 25 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 26 | 23-2919275 | OTHER | NEW JERSEY | UNITED H EALTHCARE/OXFORD |
| 27 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 28 | 3250679 | OTHER | PENNSYLVANIA | AETNA |
| 29 | DD1386 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE (GROUP) |
| 30 | 1169169 | OTHER | NEW JERSEY | AETNA |
| 31 | 5738460 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 32 | 50059325 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 33 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 34 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 35 | P00115691 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 36 | 999332 | OTHER | PENNSYLVANIA | UPMC HEALTH PLAN |
| 37 | 751462 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 38 | 1208801 | OTHER | NEW JERSEY | AETNA |
| 39 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 40 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 41 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 42 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 43 | 30028251 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 44 | 100819591 | MEDICAID | PENNSYLVANIA | |
| 45 | 174115RUZ | MEDICARE PIN | NEW JERSEY | |
