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 | 207W00000X | Ophthalmology | | 0101023876 | VIRGINIA | 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 | 1682 | OTHER | | CARE FIRST BC BS |
| 2 | 2146733 | OTHER | | OPTIMUM CHOICE PROV NO |
| 3 | ONENET PPO ALLIANCE | OTHER | | 2146733 |
| 4 | 244846 | OTHER | | NCPPO PROV NUMBER |
| 5 | 405460 | MEDICARE ID-TYPE UNSPECIFIED | DISTRICT OF COLUMBIA | MEDICARE PROVIDER NUMBER |
| 6 | 78521 | OTHER | | AETNA PROVIDER ID NUMBER |
| 7 | C62501 | MEDICARE UPIN | VIRGINIA | |
| 8 | 08 00148 | OTHER | | UNITED HEALTH CARE |
| 9 | 1682 | OTHER | | BCBS NATL CAPITAL PROV NO |
| 10 | 2146733 | OTHER | | MDIPA PROV NUMBER |
| 11 | 2146733 | OTHER | | MAMSI PROV. NUMBER |
| 12 | 274557 | OTHER | VIRGINIA | ANTHEM PROVIDER NUMBER |
| 13 | 698420 | OTHER | | FIRST HEALTH PROV NUMBER |
