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 | 213ER0200X | Podiatrist | Radiology | SC003408L | PENNSYLVANIA | No |
| 2 | 332B00000X | Durable Medical Equipment & Medical Supplies | | 0649380001 | PENNSYLVANIA | No |
| 3 | 213ES0000X | Podiatrist | Sports Medicine | SC003408L | PENNSYLVANIA | No |
| 4 | 213E00000X | Podiatrist | | SC003408L | PENNSYLVANIA | No |
| 5 | 213ES0131X | Podiatrist | Foot Surgery | SC003408L | PENNSYLVANIA | 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 | 476121 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 2 | 0575152 | OTHER | PENNSYLVANIA | AETNA |
| 3 | 073911 | OTHER | PENNSYLVANIA | BLUE SHIELD HMO |
| 4 | T87937 | MEDICARE UPIN | PENNSYLVANIA | |
| 5 | 0211163000 | OTHER | PENNSYLVANIA | BC PERSONAL CHOICE |
| 6 | 480012183 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 7 | 0649380001 | MEDICAID | PENNSYLVANIA | |
| 8 | 30263 5822 | OTHER | PENNSYLVANIA | GEISINGER GOLD |
| 9 | 74559 | OTHER | PENNSYLVANIA | MED PLUS |
| 10 | 476121 | OTHER | PENNSYLVANIA | FIRST PRIORITY FOR LIFE |
| 11 | 2Y8325 | OTHER | PENNSYLVANIA | PHS |
| 12 | 30263 5822 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 13 | 8193207 | OTHER | NEW JERSEY | UNISYS |
| 14 | 0649380001 | MEDICARE NSC | PENNSYLVANIA | |