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 | 207X00000X | Orthopaedic Surgery | | C10008890 | 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 | 3692762000 | OTHER | DELAWARE | AMERIHEALTH |
| 2 | 510370286 | OTHER | | MULTIPLAN, INC. |
| 3 | 1346240876 | OTHER | | CREENAGHT HEALTH PLAN |
| 4 | 510370286 | OTHER | | PRIVATE HEALTHCARE SYSTEMS |
| 5 | 1346240876 | MEDICAID | DELAWARE | |
| 6 | 510370286 | OTHER | | UNION LABOR LIFE INSURANCE COMPANY |
| 7 | 510370286 | OTHER | DELAWARE | DEVON HEALTH SERVICES |
| 8 | 510370286 | OTHER | | BLUE CROSS BLUE SHIELD OF DELAWARE |
| 9 | 510370286 | OTHER | | EASTERN SUSSEX PHYSICIAN ORGANIZATION, P.A. (ESPO) |
| 10 | P00712879 | OTHER | | RAILROAD MEDICARE |
| 11 | 510370286 | OTHER | DELAWARE | CIGNA |
| 12 | 510370286 | OTHER | | UNITED HEALTHCARE |
| 13 | 264933 | OTHER | | UNISON HEALTH PLAN |
| 14 | 510370286 | OTHER | | CORVEL CORPORATION |
| 15 | 1346240876 | OTHER | | COMMUNITY HEALTH PLAN |
| 16 | 4056337 | OTHER | DELAWARE | AETNA US HEALTHCARE |
| 17 | 510370286 | OTHER | DELAWARE | PERDUE FARMS, INC. |
| 18 | 510370286 | OTHER | | ONE NET PPO |
| 19 | 510370286 | OTHER | | HEALTH NET FEDERAL SERVICES / TRICARE |
| 20 | 1346240876 | OTHER | | NATIONAL CAPITAL PPO |
| 21 | 510370286 | OTHER | | OPTIMUM CHOICE |
| 22 | 510370286 | OTHER | | M.D. IPA |
| 23 | 1346240876 | OTHER | | DELAWARE PHYSICIANS CARE, INC. |
| 24 | 510370286 | OTHER | | GREAT WEST HEALTHCARE |
| 25 | 510370286 | OTHER | | MAMSI |
