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 | 207RR0500X | Internal Medicine | Rheumatology | | | No |
| 2 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | | | No |
| 3 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | | | No |
| 4 | 207XX0004X | Orthopaedic Surgery | Foot and Ankle Surgery | | | No |
| 5 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | | | No |
| 6 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | | | No |
| 7 | 208VP0000X | Pain Medicine | Pain Medicine | | | No |
| 8 | 225100000X | Physical Therapist | | | | No |
| 9 | 225200000X | Physical Therapy Assistant | | | | No |
| 10 | 225X00000X | Occupational Therapist | | | | No |
| 11 | 363AS0400X | Physician Assistant | Surgical | | | No |
| 12 | 207X00000X | Orthopaedic Surgery | | | | 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 | 0254450002 | OTHER | | MEDICARE NSC |
| 2 | CI2264 | MEDICARE PIN | | |
| 3 | 2491418 | OTHER | | AETNA GROUP # VIRGINIA |
| 4 | 176608 | OTHER | | METRO MEDICARE |
| 5 | 4695 | OTHER | | CAREFIRST BCBS DC |
| 6 | 0254450002 | MEDICARE NSC | | |
| 7 | 712403 | OTHER | | UNITED HEALTHCARE GROUP # |
| 8 | 145530100 | OTHER | | DEPARTMENT OF LABOR |
