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 | 207Q00000X | Family Medicine | | D0016458 | MARYLAND | 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 | 9094 0001 | OTHER | MARYLAND | FEDERAL BLUE SHIELD |
2 | 4050595 | OTHER | | AETNA/US HEALTHCARE |
3 | 309640 01 | OTHER | | BC/BS OF MARYLAND |
4 | 156792 | MEDICARE PIN | MARYLAND | |
5 | ========= 008 | OTHER | MARYLAND | CIGNA |
6 | B93727 | MEDICARE UPIN | MARYLAND | |
7 | 04528011 | OTHER | MARYLAND | UNITED HEALTHCARE |
8 | 875529 | OTHER | MARYLAND | MAMSI |