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 | 2085R0202X | Radiology | Diagnostic Radiology | 018933 | LOUISIANA | 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 | 101918790 | OTHER | PENNSYLVANIA | MEDICAL ASSISTANCE PA |
| 2 | 219107 | OTHER | PENNSYLVANIA | UNISON |
| 3 | 50017540 | OTHER | KENTUCKY | PASSPORT-KCR |
| 4 | E45528 | MEDICARE UPIN | | |
| 5 | 7100028580 | MEDICAID | KENTUCKY | |
| 6 | 593615 | MEDICARE PIN | KENTUCKY | |
| 7 | 5N104 | MEDICARE PIN | LOUISIANA | |
| 8 | 1467458927 | MEDICAID | VIRGINIA | |
| 9 | 8L24014 | MEDICARE PIN | | |
| 10 | 000000548194 | OTHER | KENTUCKY | ANTHEM-KCR |
| 11 | 02880871 | OTHER | NEW YORK | NY MEDICAL ASSISTANCE |
| 12 | 1019187900001 | MEDICAID | PENNSYLVANIA | |
| 13 | 397032 | MEDICARE PIN | KENTUCKY | |
| 14 | 1563209 | OTHER | PENNSYLVANIA | GATEWAY |
| 15 | 705750 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 16 | 0998898 | MEDICARE PIN | KENTUCKY | |
| 17 | 112336-FLT | MEDICARE PIN | PENNSYLVANIA | |
| 18 | 3323286 | MEDICARE PIN | KENTUCKY | |
| 19 | 3810010518 | OTHER | VIRGINIA | MEDICAID WV |
| 20 | 00011029 | MEDICARE PIN | KENTUCKY | |
| 21 | 3425392000 | OTHER | KENTUCKY | PASSPORT ADVANTAGE |
| 22 | 211195701 | OTHER | TEXAS | TPI |
| 23 | 016273P38 | MEDICARE PIN | VIRGINIA | |
| 24 | 101918790 | MEDICAID | PENNSYLVANIA | |
| 25 | 332823YH3U | MEDICARE PIN | LOUISIANA | |
| 26 | 1071748 | OTHER | WEST VIRGINIA | WV WORKERS COMP |
| 27 | 013092C19 | MEDICARE PIN | VIRGINIA | |
| 28 | FA7375331 | MEDICARE PIN | OHIO | |
| 29 | 1564931 | OTHER | PENNSYLVANIA | AETNA |
| 30 | 91729 | OTHER | KENTUCKY | SIHO-KCR |
| 31 | 112336 | MEDICARE PIN | PENNSYLVANIA | |
| 32 | 2750303 | OTHER | OHIO | OH MEDICAL ASSISTANCE |
| 33 | 1909173 | MEDICAID | LOUISIANA | |
| 34 | 2750303 | MEDICAID | OHIO | |
| 35 | P00405860 | OTHER | VIRGINIA | MEDICARE RAILROAD |
| 36 | 332823YH3V | MEDICARE PIN | LOUISIANA | |