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 | 2085R0001X | Radiology | Radiation Oncology | MD030514E | PENNSYLVANIA | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | D0067927 | MARYLAND | No |
| 3 | 2085R0001X | Radiology | Radiation Oncology | 25MA09102200 | NEW JERSEY | 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 | 0003 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BCBS |
| 2 | 0091658000 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 3 | 01666607 | OTHER | NEW JERSEY | AMERIGROUP |
| 4 | 1030965 | OTHER | PENNSYLVANIA | KEYSTONE MERCY HEALTH PLA |
| 5 | 94072503 (GETTYSBURG | OTHER | MARYLAND | CAREFIRST BCBS |
| 6 | P00928691 | OTHER | MARYLAND | RAILROAD MEDICARE (OMB) |
| 7 | 0304034 | MEDICAID | NEW JERSEY | |
| 8 | 3603456 | OTHER | MARYLAND | AMERICHOICE - BELCAMP OFFICE |
| 9 | 88102701 (GREENBELT) | OTHER | MARYLAND | CAREFIRST BCBS |
| 10 | HO0000195426 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 11 | 0008 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BCBS |
| 12 | 001167823 0005 | MEDICAID | PENNSYLVANIA | |
| 13 | 01228581 | OTHER | MARYLAND | AMERIGROUP |
| 14 | 1191658000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 15 | 195426 | OTHER | PENNSYLVANIA | HIGHMARK BCBS |
| 16 | 415607200 | MEDICAID | MARYLAND | |
| 17 | 50088876 | OTHER | PENNSYLVANIA | CAPITOL BLUE CROSS |
| 18 | 0011678230001 | MEDICAID | PENNSYLVANIA | |
| 19 | 01415563 | OTHER | MARYLAND | AMERIGROUP (OMB) |
| 20 | 2671198 | OTHER | NEW JERSEY | GHI |
| 21 | 3884504000 | OTHER | NEW JERSEY | AMERIHEALTH |
| 22 | 4339828 | OTHER | NEW JERSEY | AETNA |
| 23 | 4339828 | OTHER | MARYLAND | AETNA |
| 24 | 57573 | OTHER | | AETNA HEALTH PLAN |
| 25 | 0002 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BCBS |
| 26 | 3603455 | OTHER | MARYLAND | AMERICHOICE- BEL AIR OFFICE |
| 27 | 88102701 GREENBELT | OTHER | MARYLAND | CAREFIRST BCBS |
| 28 | 1096774 | OTHER | NEW JERSEY | CIGNA |
| 29 | 300016308 | OTHER | | RAILROAD MEDICARE |
| 30 | 4339828 | OTHER | PENNSYLVANIA | AETNA PROVIDER # |
| 31 | 94072504 LITTLESTOWN | OTHER | MARYLAND | CAREFIRST BCBS |
| 32 | 940725-01 | OTHER | MARYLAND | CAREFIRST BCBS |
| 33 | 94072506 | OTHER | MARYLAND | CAREFIRST BCBS |
| 34 | 60101993 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 35 | 6882-0006 | OTHER | MARYLAND | CAREFIRST BCBS DC |
| 36 | P01055829 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
