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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 101226688 | 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 | 216818 | OTHER | VIRGINIA | ANTHEM PROVIDER NUMBER |
| 2 | G00773 | MEDICARE ID-TYPE UNSPECIFIED | DISTRICT OF COLUMBIA | GROUP DC MEDICARE |
| 3 | 10029295 | MEDICAID | VIRGINIA | |
| 4 | 5843278 | MEDICAID | VIRGINIA | |
| 5 | 1274643 | OTHER | VIRGINIA | CIGNA HMO PROVIDER NUMBER |
| 6 | 562289471 | OTHER | VERMONT | TAX ID MANASSAS HEART |
| 7 | 2501042 | OTHER | VIRGINIA | UNITEDHEALTH CARE NUMBER |
| 8 | 5292653 | OTHER | VIRGINIA | AETNA PPO NUMBER |
| 9 | 060001014 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | VIRGINIA MEDICARE NUMBER |
| 10 | 2346100 | OTHER | VIRGINIA | AETNA HMO NUMBER |
| 11 | C06380 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | GROUP VIRGINIA MEDICARE |
| 12 | J0600001 | OTHER | VIRGINIA | CAREFIRST |
| 13 | 10390896 | OTHER | VIRGINIA | CAQH |
| 14 | 461213 | OTHER | VIRGINIA | ANTHEM FOR MANASSAS HEART |
| 15 | 481437 | OTHER | VIRGINIA | OPT/MDIPA/MAMSI |
| 16 | 70670002 | OTHER | VIRGINIA | CAREFIRST PROVIDER NUMBER |
| 17 | G80019 | MEDICARE UPIN | VIRGINIA | |
| 18 | 00A987V73 | MEDICARE ID-TYPE UNSPECIFIED | DISTRICT OF COLUMBIA | DISTRICT OF COLUM MEDICAR |
| 19 | 541984220 | OTHER | VIRGINIA | TAX ID VIRGINIA CARDIO AS |
| 20 | 00V165M83 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | MEDICARE MANASSAS HEART |