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 | 207X00000X | Orthopaedic Surgery | | 0101036194 | VIRGINIA | No |
2 | 204C00000X | Neuromusculoskeletal Medicine, Sports Medicine | | 28246 | NORTH CAROLINA | 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 | 345614 | OTHER | VIRGINIA | ANTHEM BCBS (FARMVILLE) |
2 | 134PE | OTHER | NORTH CAROLINA | BCBS OF NC |
3 | 89134PE | MEDICAID | NORTH CAROLINA | |
4 | 4131313 | OTHER | VIRGINIA | AETNA |
5 | 465999 | OTHER | NORTH CAROLINA | ANTHEM BCBS |
6 | E40688 | MEDICARE UPIN | | |
7 | 2281089A | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDICARE PROVIDER ID |
8 | 1245206820 | MEDICAID | VIRGINIA | |
9 | 62791 | OTHER | NORTH CAROLINA | MAMSI PROVIDER ID |
10 | 309283 | OTHER | VIRGINIA | ANTHEM BCBS |
11 | E40688 | MEDICARE UPIN | NORTH CAROLINA | |
12 | 134PE | OTHER | NORTH CAROLINA | STATE OF NC |
13 | 2333742 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDICARE ID |
14 | 00X677C03 | MEDICARE PIN | VIRGINIA | |
15 | 55036 | OTHER | NORTH CAROLINA | SENTARA PROVIDER ID |
16 | 345614 | OTHER | VIRGINIA | ANTHEM |
17 | 345614 | OTHER | VIRGINIA | ANTHEM HEALTH KEEPERS (FARMVILLE) |
18 | POOO26558 | OTHER | NORTH CAROLINA | RAIL ROAD MEDICARE |
19 | 014542S53 | OTHER | VIRGINIA | MEDICARE |
20 | 1425298 | OTHER | VIRGINIA | CIGNA |
21 | 161669037 | OTHER | NORTH CAROLINA | TAX ID |
22 | P00623304 | MEDICARE PIN | VIRGINIA | |