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 | 208800000X | Urology | | 0101 033452 | VIRGINIA | No |
| 2 | 208800000X | Urology | | 042-0012170 | VERMONT | 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 | 45722 | OTHER | VIRGINIA | SENTARA FAMILY CARE |
| 2 | 1478176 | OTHER | VERMONT | CIGNA |
| 3 | 2582 | OTHER | VIRGINIA | CIGNA |
| 4 | 66241 | OTHER | VIRGINIA | CARENET EFF 111506 |
| 5 | C47163 | MEDICARE UPIN | VIRGINIA | |
| 6 | 1900011 | OTHER | VIRGINIA | UNITED HEALTHCARE |
| 7 | 247815 | OTHER | VIRGINIA | ANTHEM BCBS |
| 8 | 3016615 | OTHER | VERMONT | MVP |
| 9 | 340001591 | OTHER | VIRGINIA | RAILROAD MEDICARE |
| 10 | 1018994 | MEDICAID | VERMONT | |
| 11 | 642070000-00 | OTHER | VIRGINIA | QUALCHOICE |
| 12 | 24388 | OTHER | VIRGINIA | ALLIANCE |
| 13 | 497602109 | OTHER | VIRGINIA | TRICARE |
| 14 | 32000393 | MEDICAID | NEW HAMPSHIRE | |
| 15 | 3762531 | OTHER | VIRGINIA | AETNA HMO |
| 16 | 447989 | OTHER | VIRGINIA | SOUTHERN HEALTH EFF111506 |
| 17 | 1225092794 | MEDICAID | VIRGINIA | |
| 18 | 00X405U02 | MEDICARE PIN | VIRGINIA | |
| 19 | 002130301 | OTHER | | MEDICARE PTAN |
| 20 | 59294 | OTHER | VIRGINIA | SOUTHERN HEALTH |
| 21 | 36538 | OTHER | VIRGINIA | CARENET |
| 22 | P00434719 | MEDICARE PIN | VIRGINIA | |
| 23 | 4063408 | OTHER | VIRGINIA | AETNA PPO |