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 | 207LP2900X | Anesthesiology | Pain Medicine | MD048442L | PENNSYLVANIA | Yes |
| 2 | 207LP2900X | Anesthesiology | Pain Medicine | 25MA06859100 | NEW JERSEY | No |
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 | 0141062 | OTHER | PENNSYLVANIA | CIGNA |
| 2 | 1162120 | OTHER | PENNSYLVANIA | HORIZON MERCY |
| 3 | 22-1994560 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 4 | 22-1994560 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 5 | 3801073 | OTHER | PENNSYLVANIA | AETNA |
| 6 | 50052989 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 7 | 3006328 | OTHER | PENNSYLVANIA | AETNA |
| 8 | 50059327 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 9 | 0676444000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 10 | 1162120 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 11 | 1201397 | OTHER | NEW JERSEY | AETNA |
| 12 | 146710 | OTHER | PENNSYLVANIA | UNISON |
| 13 | 22-1994560 | OTHER | NEW JERSEY | UNITED HEALTHCARE/OXFORD |
| 14 | 22-1994560 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 15 | 22-1994560 | OTHER | NEW JERSEY | FIRST MCO |
| 16 | 23-2919275 | OTHER | PENNSYLVANIA | QUALCARE |
| 17 | 23-2919275 | OTHER | PENNSYLVANIA | DEVON |
| 18 | 23-2919275 | OTHER | NEW JERSEY | UNITED HEALTHCARE |
| 19 | 23-2919275 | OTHER | PENNSYLVANIA | PROCURA MANAGEMENT |
| 20 | 424454 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 21 | 001646007 | MEDICAID | PENNSYLVANIA | |
| 22 | 050083449 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 23 | 23-2919275 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE/OXFORD |
| 24 | 22-1994560 | OTHER | PENNSYLVANIA | DEVON |
| 25 | 30013543 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 26 | 0676444000 | OTHER | PENNSYLVANIA | IBC PRODUCTS |
| 27 | 22-1994560 | OTHER | PENNSYLVANIA | QUALCARE |
| 28 | 23-2919275 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 29 | 23-2919275 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 30 | 23-2919275 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 31 | P00210395 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 32 | 22-1994560 | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD |
| 33 | 23-2919275 | OTHER | PENNSYLVANIA | FIRST MCO |
| 34 | 5616087 | OTHER | PENNSYLVANIA | FIRST HEALTH NETWORK |
| 35 | 999456 | OTHER | PENNSYLVANIA | UPMC HEALTH PLAN |
| 36 | 1770846 | OTHER | NEW JERSEY | AETNA |
| 37 | 22-1994560 | OTHER | PENNSYLVANIA | GREAT WEST HEALTHCARE |
| 38 | 424454 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |