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 | 207R00000X | Internal Medicine | | MD437988 | PENNSYLVANIA | No |
2 | 208M00000X | Hospitalist | | MD437988 | 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 | 9263404 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
2 | 1007307260034 | OTHER | PENNSYLVANIA | MEDICAID GROUP # |
3 | MD437988 | OTHER | PENNSYLVANIA | MEDICAL LICENCE |
4 | P00768398 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
5 | 120420410 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
6 | 25-1716306 | OTHER | PENNSYLVANIA | INFORMED |
7 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
8 | 25-1716306 | OTHER | PENNSYLVANIA | SOUTH CENTRAL PREFERRED |
9 | 50088509 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS |
10 | TA2123270 | OTHER | PENNSYLVANIA | HIGHMARK BLUESHIELD |
11 | 1346417730 | OTHER | PENNSYLVANIA | HEALTH AMERICA |
12 | 1585291 | OTHER | PENNSYLVANIA | GATEWAY |
13 | 102372750 0001 | MEDICAID | PENNSYLVANIA | |
14 | 102372750 0002 | MEDICAID | PENNSYLVANIA | |
15 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
16 | 25-1716306 | OTHER | PENNSYLVANIA | GREATWEST HEALTHCARE |
17 | 2507285 | OTHER | PENNSYLVANIA | MAMSI GROUP # (WH) |
18 | 289493 | OTHER | PENNSYLVANIA | UNISON |
19 | 867633 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
20 | 6024884 | OTHER | PENNSYLVANIA | AETNA HMO |
21 | 1346417730 | OTHER | PENNSYLVANIA | FIRST HEALTH |
22 | 2183091 | OTHER | PENNSYLVANIA | MAMSI GROUP # (CH) |
23 | 25-1716306 | OTHER | PENNSYLVANIA | MULTIPLAN/PHCS |
24 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |