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 | 208600000X | Surgery | | 0101229793 | VIRGINIA | No |
| 2 | 208600000X | Surgery | | D0069715 | MARYLAND | No |
| 3 | 208600000X | Surgery | | C10009853 | DELAWARE | 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 | 167981YZC | MEDICARE PIN | DELAWARE | |
| 2 | 009017EEE | MEDICARE PIN | VIRGINIA | |
| 3 | 222101209 | OTHER | MARYLAND | MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC - MEDICAID GROUP |
| 4 | 1821030156 | OTHER | MARYLAND | MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC - GENERAL SURGERY NPI |
| 5 | KR10ME | OTHER | MARYLAND | MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC - BCBS MD GROUP |
| 6 | 1851473722 | OTHER | MARYLAND | MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC - GROUP NPI |
| 7 | H55016 | MEDICARE UPIN | VIRGINIA | |
| 8 | 624316 | OTHER | DISTRICT OF COLUMBIA | MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC - MEDICARE GOUP |
| 9 | B776 | OTHER | DISTRICT OF COLUMBIA | MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC - BCBS DC GROUP |
| 10 | 7303882 | MEDICAID | VIRGINIA | |