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 | | D0037064 | 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 | 100064 | OTHER | MARYLAND | AETNA CAPITATED KI |
| 2 | 2114468 | OTHER | MARYLAND | MAMSI SPECIALIST KI |
| 3 | 100059 | OTHER | MARYLAND | AETNA CAPITATED BN |
| 4 | 351089-12 | OTHER | MARYLAND | CAREFIRST MD RENDERING KI |
| 5 | 1406209 | OTHER | MARYLAND | CIGNA PIN |
| 6 | 235422 | OTHER | MARYLAND | MAMSI SPECIALIST BN |
| 7 | 80083145 | OTHER | MARYLAND | RR MEDICARE BN |
| 8 | 80083132 | OTHER | MARYLAND | RR MEDICARE KI |
| 9 | 526171600 | MEDICAID | MARYLAND | |
| 10 | P11963 | OTHER | MARYLAND | CAREFIRST MPOS |
| 11 | 8114468 | OTHER | MARYLAND | MAMSI PRIMARY CARE |
| 12 | 351089-01 | OTHER | MARYLAND | CAREFIRST MD RENDERING BN |
| 13 | 4567843 | OTHER | MARYLAND | AETNA FEE FOR SERVICE |
| 14 | 013200 | OTHER | MARYLAND | JHHC PROVIDER NUMBER |
| 15 | 7605-0042 | OTHER | MARYLAND | CAREFIRST BLUECHOICE |
| 16 | D09217 | MEDICARE UPIN | | |
| 17 | 226L292B | MEDICARE PIN | MARYLAND | |
| 18 | 835422 | OTHER | MARYLAND | MAMSI PRIMARY CARE BN |
| 19 | 227L311B | MEDICARE PIN | MARYLAND | |