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 | 207VM0101X | Obstetrics & Gynecology | Maternal & Fetal Medicine | MD019562E | 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 | 3716959 | OTHER | PENNSYLVANIA | AETNA US HEALTHCARE GROUP |
| 2 | 33657 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 3 | 33658 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 4 | 33659 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 5 | 3716970 | OTHER | PENNSYLVANIA | AETNA US HEALTHCARE HMO |
| 6 | 02640 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 7 | 30018991 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 8 | 4092729 | OTHER | PENNSYLVANIA | AETNA US HEALTHCARE |
| 9 | 30018989 | OTHER | PENNSYLVANIA | KEYSTONE MERCY GROUP |
| 10 | 001055531 | MEDICAID | PENNSYLVANIA | |
| 11 | 149436 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 12 | 0052930000 | OTHER | PENNSYLVANIA | BC/BS KEYSTONE, PERSONAL |
| 13 | 1652891 | OTHER | PENNSYLVANIA | BC/BS HIGHMARK GROUP |
| 14 | 2330386000 | OTHER | PENNSYLVANIA | BC/BS KEY, PER. GROUP |
| 15 | 0105553107 | OTHER | PENNSYLVANIA | AMERICHOICE |
| 16 | 149436 | OTHER | PENNSYLVANIA | BC/BS SHIELD HIGHMARK |
| 17 | C31934 | MEDICARE UPIN | | |
| 18 | 802212TGW | MEDICARE PIN | PENNSYLVANIA | |
