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 | 213ES0131X | Podiatrist | Foot Surgery | SC003890L | 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 | 780195 | OTHER | PENNSYLVANIA | BLUE SHIELD PERSONAL CARE |
| 2 | 86612 | OTHER | PENNSYLVANIA | UNISON |
| 3 | 780195 | OTHER | PENNSYLVANIA | FEDERAL BLUE SHIELD |
| 4 | P00089348 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 5 | 780195 | MEDICARE PIN | PENNSYLVANIA | |
| 6 | 780195 | OTHER | PENNSYLVANIA | FIRST PRIORITY HEALTH |
| 7 | 780195 | OTHER | PENNSYLVANIA | FREEDOM BLUE |
| 8 | 780195 | OTHER | PENNSYLVANIA | ACCESS |
| 9 | U58555 | OTHER | PENNSYLVANIA | STERLING |
| 10 | 000000086612 | MEDICAID | PENNSYLVANIA | |
| 11 | 2144133 | OTHER | PENNSYLVANIA | AETNA |
| 12 | 5521062 | OTHER | PENNSYLVANIA | AETNA PPO |
| 13 | 86612 | OTHER | PENNSYLVANIA | MEDPLUS |
| 14 | 17105 6484 | OTHER | PENNSYLVANIA | GEISINGER HEALTH |
| 15 | 247931 | OTHER | | HEALTNET |
| 16 | 2Y7931 | OTHER | PENNSYLVANIA | HEAL |
| 17 | 780195 | OTHER | PENNSYLVANIA | PENNSYLVANIA BLUE SHIELD |
| 18 | U58555 | MEDICARE UPIN | | |
| 19 | 2144133 | OTHER | PENNSYLVANIA | US HEALTHCARE |
| 20 | 247931 | OTHER | PENNSYLVANIA | HEALTHNET |
| 21 | 780195 | OTHER | PENNSYLVANIA | FIRST PRIORITY LIFE |
| 22 | BR780195 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 23 | 17105 6484 | OTHER | PENNSYLVANIA | GEISINGER GOLD |
| 24 | 2Y7931 | OTHER | PENNSYLVANIA | HAMER |