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 | 208100000X | Physical Medicine & Rehabilitation | | MD040509E | 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 | 0542558000 | OTHER | | AMERIHEALTH INC |
| 2 | 232737884 | OTHER | | BERKSHIRE HEALTH PARTNERS |
| 3 | 232737884 | OTHER | | AMERIHEALTH ADMINISTRATOR |
| 4 | 335169 | OTHER | | HEALTH AMERICA HLTH ASSUR |
| 5 | 000000129591 | OTHER | | THREE RIVERS UNISON |
| 6 | 02329500 | OTHER | | CAPITAL BLUE CROSS CAPITA |
| 7 | 1104520 | OTHER | | KEYSTONE MERCY |
| 8 | 706725 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 9 | 0542558000 | OTHER | | KEYSTONE HEALTH PLAN EAST |
| 10 | 0542558000 | OTHER | | INDEPENDENCE BLUE CROSS |
| 11 | 0706725 | OTHER | | KEYSTONE HLTH PLAN CENTRA |
| 12 | 3919 | OTHER | | GEISINGER HEALTH PLAN |
| 13 | E70135 | MEDICARE UPIN | | |
| 14 | 0012763630001 | MEDICAID | PENNSYLVANIA | |
| 15 | 1523181 | OTHER | | GATEWAY & GATEWAY MEDICAR |
| 16 | 20007755 | OTHER | | AMERIHEALTH MERCY |
| 17 | 000706725 | OTHER | | HIGHMARK BLUE SHIELD PREM |
| 18 | 0951043 | OTHER | | AETNA |