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 | 207V00000X | Obstetrics & Gynecology | | MD072147L | 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 | 001846634 0002 | MEDICAID | PENNSYLVANIA | |
| 2 | 1341698 | OTHER | PENNSYLVANIA | AETNA HMO |
| 3 | 25-1716306 | OTHER | PENNSYLVANIA | MULTIPLAN/PHCS |
| 4 | 120420413 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
| 5 | 186917 | OTHER | PENNSYLVANIA | UNISON |
| 6 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
| 7 | 25-1716306 | OTHER | PENNSYLVANIA | INFORMED |
| 8 | 7457237 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
| 9 | G920-0059/KV77CU | OTHER | PENNSYLVANIA | CAREFIRST |
| 10 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |
| 11 | 867633 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
| 12 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
| 13 | 440490 | OTHER | PENNSYLVANIA | HEALTH AMERICA |
| 14 | MD072147L | OTHER | PENNSYLVANIA | LICENSE |
| 15 | 1559303 | OTHER | PENNSYLVANIA | GATEWAY |
| 16 | 25-1716306 | OTHER | PENNSYLVANIA | SOUTH CENTRAL PREFERRED |
| 17 | P00377960 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 18 | 2144240 | OTHER | PENNSYLVANIA | MAMSI |
| 19 | 25-1716306 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 20 | 50060635 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS |
| 21 | 928593 | OTHER | PENNSYLVANIA | HIGHMARK BLUESHIELD |
| 22 | 1007307260034 | OTHER | PENNSYLVANIA | MEDICAID GROUP # |
