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 | 207QG0300X | Family Medicine | Geriatric Medicine | 0101238143 | VIRGINIA | No |
| 2 | 207QG0300X | Family Medicine | Geriatric Medicine | ME94903 | FLORIDA | No |
| 3 | 207QG0300X | Family Medicine | Geriatric Medicine | MD8257 | DISTRICT OF COLUMBIA | No |
| 4 | 207QG0300X | Family Medicine | Geriatric Medicine | D0021954 | MARYLAND | No |
| 5 | 208600000X | Surgery | | 0101238143 | VIRGINIA | No |
| 6 | 208600000X | Surgery | | ME94903 | FLORIDA | No |
| 7 | 208600000X | Surgery | | D0021954 | MARYLAND | No |
| 8 | 208D00000X | General Practice | | 0101238143 | VIRGINIA | No |
| 9 | 208D00000X | General Practice | | ME94903 | FLORIDA | No |
| 10 | 208D00000X | General Practice | | MD8257 | DISTRICT OF COLUMBIA | No |
| 11 | 208D00000X | General Practice | | D0021954 | MARYLAND | No |
| 12 | 207QG0300X | Family Medicine | Geriatric Medicine | MD0000049564 | TENNESSEE | No |
| 13 | 208D00000X | General Practice | | MD0000049564 | TENNESSEE | No |
| 14 | 208600000X | Surgery | | MD8257 | DISTRICT OF COLUMBIA | No |
| 15 | 208600000X | Surgery | | MD0000049564 | TENNESSEE | 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 | 6199 | OTHER | MARYLAND | BLUE CROSS BLUE SHIELD |
| 2 | C87750 | MEDICARE UPIN | | |
| 3 | 112505 | OTHER | | AARP |
| 4 | 0495776 | OTHER | | AETNA HEALTH MGMNT, LLC |
| 5 | 2754 | OTHER | DISTRICT OF COLUMBIA | BLUE CROSS BLUE SHIELD |
| 6 | 116726 | MEDICARE ID-TYPE UNSPECIFIED | DISTRICT OF COLUMBIA | WASH DC & METRO AREA |
| 7 | 8257207750000 | OTHER | | TRICARE |