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 | 2471N0900X | Radiologic Technologist | Nuclear Medicine Technology | 3054015 | 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 | 001339666 | OTHER | | INDEPENDENCE BLUE CROSS P |
| 2 | VA1339666 | OTHER | | PA BLUE SHIELD |
| 3 | 01887332 | MEDICAID | PENNSYLVANIA | |
| 4 | ========= | OTHER | | PREFERRED CARE PA MAGNA C |
| 5 | 7633253 | OTHER | | AETNA US HEALTHCARE TRADI |
| 6 | ========= | OTHER | | TRICARE CHAMPUS |
| 7 | ========= | OTHER | NEW JERSEY | HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY |
| 8 | 050537 | MEDICARE PIN | PENNSYLVANIA | |
| 9 | 002104142 | OTHER | | UNITED HEALTHCARE |
| 10 | P00110029 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 11 | 2035663000 | OTHER | | INDEPENDENCE BLUE CROSS H |
| 12 | ========= | OTHER | | MULTIPLAN |
| 13 | 02986400 | OTHER | | CAPITAL ADVANTAGE INSURAN |
| 14 | 118732 | OTHER | | THREE RIVERS HEALTH PLANS |
| 15 | 2572590 | OTHER | | AETNA US HEALTHCARE HMO |
| 16 | ========= | OTHER | | INTERGROUP |
| 17 | ========= | OTHER | | FIRST HEALTH |
