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 | 213E00000X | Podiatrist | | 00337 | WEST VIRGINIA | No |
| 2 | 213E00000X | Podiatrist | | 01261 | MARYLAND | 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 | 1255339511 | OTHER | MARYLAND | INDIVIDUAL NPI |
| 2 | =========0001 | OTHER | WEST VIRGINIA | MTST BCBS |
| 3 | P00039957 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | RAIL ROAD MEDICARE |
| 4 | 61489306 KFT9 | OTHER | MARYLAND | BLUECROSSBLUESHIELD |
| 5 | CI9337831 CI0856044 | MEDICARE ID-TYPE UNSPECIFIED | WEST VIRGINIA | GROUP AND INDIVIDUAL NUMB |
| 6 | 0100089000 | MEDICAID | WEST VIRGINIA | |
| 7 | 4760610002 | MEDICARE NSC | MARYLAND | |
| 8 | 4760610003 | MEDICARE NSC | WEST VIRGINIA | |
| 9 | U71826 | MEDICARE UPIN | MARYLAND | |
| 10 | 616600800 | MEDICAID | MARYLAND | |
| 11 | 7308039MD2 | OTHER | MARYLAND | MAMSI-MDIPA-OPTCHOICE |
| 12 | 669M 182F | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | |