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 | 207RN0300X | Internal Medicine | Nephrology | 18145 | WEST VIRGINIA | No |
| 2 | 207RN0300X | Internal Medicine | Nephrology | 35069336A | OHIO | No |
| 3 | 207RN0300X | Internal Medicine | Nephrology | MD050934L | PENNSYLVANIA | No |
| 4 | 207RN0300X | Internal Medicine | Nephrology | M-1632 | GUAM | 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 | AL0855403 | MEDICARE PIN | WEST VIRGINIA | |
| 2 | A18145B | OTHER | WEST VIRGINIA | HEALTH PLAN OF UPPER OHIO |
| 3 | 84134 | OTHER | WEST VIRGINIA | COVENTRY/CARELINK |
| 4 | 0078188000 | MEDICAID | WEST VIRGINIA | |
| 5 | 776471 | MEDICARE PIN | PENNSYLVANIA | |
| 6 | 390008192 | MEDICARE PIN | WEST VIRGINIA | |
| 7 | 000776471 | OTHER | OHIO | BLUE CROSS BLUE SHIELD |
| 8 | CR305Z | MEDICARE UPIN | GUAM | |
| 9 | G05735 | MEDICARE UPIN | | |
| 10 | AL0855404 | MEDICARE PIN | OHIO | |
| 11 | 000776471 | OTHER | PENNSYLVANIA | BLUE CROSS BLUE SHIELD |
| 12 | M-1632 | OTHER | GUAM | MEDICAL LICENSE |
| 13 | H107906 | MEDICARE UPIN | GUAM | |
| 14 | 0181860 | MEDICAID | OHIO | |
| 15 | 000776471 | OTHER | WEST VIRGINIA | BLUE CROSS BLUE SHIELD |
