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 | 0101239644 | VIRGINIA | Yes |
| 2 | 207R00000X | Internal Medicine | | 010239644 | VIRGINIA | 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 | PAR | OTHER | VIRGINIA | FIRST HEALTH COMMERCIAL (600 GRESAHM DR) |
| 2 | 9447132 | OTHER | VIRGINIA | AETNA (CARDIOVASCULAR ASSOC LTD) |
| 3 | 353846 | OTHER | VIRGINIA | ANTHEM BCBS (CARDIOVASCULAR ASSOC LTD) |
| 4 | 353849 | OTHER | VIRGINIA | ANTHEM - 600 GRESHAM DRIVE |
| 5 | -001 | OTHER | VIRGINIA | TRICARE |
| 6 | 2181285 | OTHER | VIRGINIA | MAMSI/MDIPA (CARDIOVASCULAR ASSOC LTD) |
| 7 | 3181555 | OTHER | | UHC/MAMSI (EVMS HEALTH SERVICES) |
| 8 | 3636274 | OTHER | VIRGINIA | CIGNA (CARDIOVASCULAR ASSOC LTD) |
| 9 | 1205047628 | MEDICAID | VIRGINIA | |
| 10 | 5909179 | MEDICAID | NORTH CAROLINA | |
| 11 | 09179 | OTHER | NORTH CAROLINA | BC/BS (EVMS HEALTH SERVICES) |
| 12 | 3636274 | OTHER | VIRGINIA | CIGNA (600 GRESHAM DR) |
| 13 | PAR | OTHER | VIRGINIA | VA PREMIER HEALTH (EVMS HEALTH SERVICES) |
| 14 | 148E5 | OTHER | NORTH CAROLINA | BCBS (CARDIOVASCULAR ASSOC LTD) |
| 15 | 10035982 | OTHER | VIRGINIA | SENTARA/OPTIMA (600 GRESHAM DR) |
| 16 | 1205047628 | OTHER | VIRGINIA | TRICARE |
| 17 | PAR | OTHER | VIRGINIA | VA HEALTH NETWORK (600 GRESHAM DR) |
