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 | 207NS0135X | Dermatology | Procedural Dermatology | 35052867 | OHIO | 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 | 102510 | OTHER | | KAISER PERMANENTE |
| 2 | 3415377930001 | OTHER | | CIGNA |
| 3 | R52867 | OTHER | | SUMACARE |
| 4 | 3415377930001 | OTHER | | NIPPON LIFE INSURANCE |
| 5 | R52867 | OTHER | | APEX |
| 6 | 341537793 | OTHER | | PROFESSIONAL CLAIMS MANAGEMENT |
| 7 | 3415377930001 | OTHER | | CHRISTIAN BROTHERS |
| 8 | 3415377930001 | OTHER | | RETIREE MEDICAL INSURANCE |
| 9 | 0631034 | OTHER | OHIO | PEOPLE'S HEALTH PLAN |
| 10 | 341537793 | OTHER | | SECURE HORIZONS |
| 11 | 3415377930001 | OTHER | | TPA |
| 12 | 07000311 | OTHER | OHIO | RAILROAD MEDICARE |
| 13 | 3415377930001 | OTHER | | COMMUNITY INSURANCE |
| 14 | 3415377930001 | OTHER | | EMERALD HEALTH NETWORK |
| 15 | 3415377930001 | OTHER | | EXPACARE |
| 16 | 3415377930001 | OTHER | | PRINCIPAL LIFE INSURANCE |
| 17 | 341537793026 | OTHER | OHIO | CARESOURCE |
| 18 | 0582313 | MEDICARE PIN | OHIO | |
| 19 | 341537793 | OTHER | | MAIL HANDLERS |
| 20 | 341537793 | OTHER | | NALC |
| 21 | 341537793 | OTHER | | TRICARE |
| 22 | 34153779300 | OTHER | OHIO | CAREWORKS |
| 23 | 34153779300 | OTHER | | MEDICAL ADMINISTRATORS |
| 24 | 3415377930001 | OTHER | | HEALTHLINK |
| 25 | 3415377930001 | OTHER | | OHIO HEALTH CHOICE |
| 26 | 3415377930001 | OTHER | | UNITED HEALTHCARE |
| 27 | D32422 | MEDICARE UPIN | OHIO | |
| 28 | 000000133524 | OTHER | | BLUE CROSS / BLUE SHIELD |
| 29 | 736416 | OTHER | | BUCKEYE |
| 30 | 34153779300 | OTHER | OHIO | BUREAU OF WORKERS COMPENSATION |
| 31 | 3415377930001 | OTHER | | GREAT WEST |
| 32 | 3415377930001 | OTHER | | FIRST HEALTH |
| 33 | 341537793 | OTHER | | AETNA |
| 34 | 341537793 | OTHER | | HUMANA |
| 35 | 3415377930001 | OTHER | | OHIO CONFERENCE OF PLASTERERS |
| 36 | 3415377930001 | OTHER | | STAR ADMINISTRATION SERVICES |
| 37 | 3415377930001 | OTHER | | UNICARE |
| 38 | 3415377930001 | OTHER | | UNITED AMERICAN INSURANCE |
| 39 | 72503454006 | OTHER | | MEDICAL MUTUAL OF OHIO |
| 40 | 0631034 | MEDICAID | OHIO | |
| 41 | 3415377930001 | OTHER | | FLORIDA HEALTH CARE PLANS |
| 42 | 3415377930001 | OTHER | | GOLDEN RULE |
| 43 | 351358 | OTHER | OHIO | WELLCARE |
