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 | 2085U0001X | Radiology | Diagnostic Ultrasound | 39719 | NORTH CAROLINA | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | 39719 | NORTH CAROLINA | Yes |
| 3 | 2085P0229X | Radiology | Pediatric Radiology | 39719 | NORTH CAROLINA | No |
| 4 | 2085R0001X | Radiology | Radiation Oncology | 39719 | NORTH CAROLINA | No |
| 5 | 2085R0205X | Radiology | Radiological Physics | 39719 | NORTH CAROLINA | No |
| 6 | 2085R0203X | Radiology | Therapeutic Radiology | 39719 | NORTH CAROLINA | No |
| 7 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 39719 | NORTH CAROLINA | No |
| 8 | 2085N0904X | Radiology | Nuclear Radiology | 39719 | NORTH CAROLINA | No |
| 9 | 207U00000X | Nuclear Medicine | | 39719 | NORTH CAROLINA | No |
| 10 | 2085B0100X | Radiology | Body Imaging | 39719 | NORTH CAROLINA | No |
| 11 | 2085D0003X | Radiology | Diagnostic Neuroimaging | 39719 | NORTH CAROLINA | No |
| 12 | 2085N0700X | Radiology | Neuroradiology | 39719 | NORTH CAROLINA | 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 | 760158 | OTHER | NORTH CAROLINA | MAMSI |
| 2 | 153000500 | OTHER | NORTH CAROLINA | DOL |
| 3 | 1141C | OTHER | NORTH CAROLINA | BCBS OF NC |
| 4 | 891141C | MEDICAID | NORTH CAROLINA | |
| 5 | C5188 | OTHER | NORTH CAROLINA | MEDCOST |
| 6 | 150918 | OTHER | NORTH CAROLINA | VYTRA |