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 | 207W00000X | Ophthalmology | | | | 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 | 000000139485 | OTHER | PENNSYLVANIA | UNISON MEDPLUS |
| 2 | 02297100 | OTHER | PENNSYLVANIA | CAPITAL BC KEYSTONE BLUE |
| 3 | 181248 | OTHER | PENNSYLVANIA | BLUE SHIELD VISION PLANS |
| 4 | 505963 | OTHER | PENNSYLVANIA | AETNA |
| 5 | 700616 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 6 | 0010897540025 | MEDICAID | PENNSYLVANIA | |
| 7 | 0617860003 | MEDICARE NSC | PENNSYLVANIA | |
| 8 | 072304 | OTHER | PENNSYLVANIA | FIRST PRIORITY HEALTH |
| 9 | 181248 | OTHER | PENNSYLVANIA | BLUE SHIELD FEDERAL EMPLO |
| 10 | 181248 | OTHER | PENNSYLVANIA | FREEDOM BLUE |
| 11 | 02297100 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 12 | 02297100 | OTHER | PENNSYLVANIA | CAPITAL BC KEYSTONE SENIO |
| 13 | 1996 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 14 | 181248 | MEDICARE PIN | PENNSYLVANIA | |
| 15 | 1512852 | OTHER | PENNSYLVANIA | GATEWAY HEALTH PLAN |
| 16 | 20008501 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY HEALTH |
| 17 | 0090282000 | OTHER | PENNSYLVANIA | BLUE SHIELD PERSONAL CHOI |
| 18 | 181248 | OTHER | PENNSYLVANIA | BLUE SHIELD OF PA |
| 19 | 181248 | OTHER | PENNSYLVANIA | FIRST PRIORITY LIFE |
| 20 | 1996 | OTHER | PENNSYLVANIA | GEISINGER GOLD HEALTH PLA |
