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 | | | | No |
| 2 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | | | No |
| 3 | 363AS0400X | Physician Assistant | Surgical | | | No |
| 4 | 207RR0500X | Internal Medicine | Rheumatology | | | No |
| 5 | 225X00000X | Occupational Therapist | | | | No |
| 6 | 225100000X | Physical Therapist | | | | No |
| 7 | 207XX0004X | Orthopaedic Surgery | Foot and Ankle Surgery | | | No |
| 8 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | | | No |
| 9 | 207XS0117X | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | | | No |
| 10 | 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 | 145530100 | OTHER | | DEPARTMENT OF LABOR PROV# |
| 2 | B93008 | MEDICARE UPIN | | |
| 3 | B93412 | MEDICARE UPIN | | |
| 4 | G86663 | MEDICARE UPIN | | |
| 5 | 1184930885 | OTHER | | CLINTON MARYLAND LOCATION NPI |
| 6 | 108844 | MEDICARE UPIN | | |
| 7 | 462*L | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | MARYLAND MEDICARE PROV # |
| 8 | DG8302 | OTHER | MARYLAND | RAILROAD MEDICARE |
| 9 | B92934 | MEDICARE UPIN | | |
| 10 | 1548576242 | OTHER | | ALEXANDRIA VIRGINIA LOCATION NPI |
| 11 | H43852 | MEDICARE UPIN | | |
| 12 | 176608 | MEDICARE ID-TYPE UNSPECIFIED | DISTRICT OF COLUMBIA | METRO MEDICARE GRP PROV # |
| 13 | 1942514450 | OTHER | | MOUNT VERNON VIRGINIA LOCATION NPI |
| 14 | 2803674 | OTHER | | AETNA GROUP PROVIDER # WALDORF LOCATION |
| 15 | 0254450001 | OTHER | | MEDICARE NSC |
| 16 | E95254 | MEDICARE UPIN | | |
| 17 | 0254450001 | MEDICARE NSC | | |
| 18 | 1205140639 | OTHER | | LORTON VIRGINIA LOCATION NPI |
| 19 | B92844 | MEDICARE UPIN | | |
| 20 | E61710 | MEDICARE UPIN | | |
| 21 | 2491418 | OTHER | | AETNA GROUP PROVIDER # VIRGINIA LOCATION |
| 22 | 712403 | OTHER | | UNITED HEALTH CARE/MAMSI GROUP PROVIDER# |
| 23 | CI2264 | OTHER | | RAILROAD MEDICARE PTAN |
| 24 | 4695 | OTHER | DISTRICT OF COLUMBIA | BCBS NCA GRP PROV# |
| 25 | 21D1105636 | OTHER | | CLIA NUMBER |
| 26 | I20600 | MEDICARE UPIN | | |
| 27 | I60636 | MEDICARE UPIN | | |
| 28 | 0455415 | OTHER | | AETNA GROUP PROVIDER # CLINTON LOCATION |
| 29 | S176 | OTHER | MARYLAND | BCBS MD GRP PROVIDER# |
| 30 | 1194039511 | OTHER | | SPRINGFIELD VIRGINIA LOCATION NPI |
| 31 | 1801102504 | OTHER | | WALDORF MARYLAND LOCATION NPI |