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 | 213E00000X | Podiatrist | | SC0047421 | 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 | 78203 | OTHER | PENNSYLVANIA | AETNA GROUP PROVIDER# |
| 2 | 827 | OTHER | PENNSYLVANIA | HEALTH AMERICA GROUP# |
| 3 | 000000205717 | OTHER | PENNSYLVANIA | ANTHEM PROVIDER# |
| 4 | 1390124 | OTHER | PENNSYLVANIA | INDIVIDUAL PROVIDER# |
| 5 | 318279 | OTHER | PENNSYLVANIA | UPMC INDIVIDUAL PROVIDER# |
| 6 | 188543 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | GROUP MEDICARE PROVIDER# |
| 7 | 0018962330002 | MEDICAID | PENNSYLVANIA | |
| 8 | 56407 | OTHER | PENNSYLVANIA | UNISON GROUP PROVIDER# |
| 9 | 188543 | OTHER | PENNSYLVANIA | GROUP PROVIDER# |
| 10 | 13914 | OTHER | PENNSYLVANIA | ELDER HEALTH PROVIDER# |
| 11 | 058219 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | INDIVIDUAL MEDICARE# |
| 12 | 7955556 | OTHER | PENNSYLVANIA | AETNA INDIVIDUAL PROV # |
| 13 | U90336 | MEDICARE UPIN | PENNSYLVANIA | |
| 14 | 132077 | OTHER | PENNSYLVANIA | UNISON INDIVIDUAL # |
| 15 | 200065 | OTHER | PENNSYLVANIA | HEALTH AMERICA INDIVID# |
| 16 | 251561562 | OTHER | PENNSYLVANIA | RR MEDICARE PROVIDER# |
| 17 | 251561562 | OTHER | PENNSYLVANIA | GROUP# |
| 18 | 0011858030001 | MEDICAID | PENNSYLVANIA | |
