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 | 207R00000X | Internal Medicine | | MD420611 | PENNSYLVANIA | No |
| 2 | 208M00000X | Hospitalist | | MD420611 | 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 | 001923420 0003 | MEDICAID | PENNSYLVANIA | |
| 2 | 25-1716306 | OTHER | PENNSYLVANIA | SOUTH CENTRAL PREFERRED |
| 3 | 50055993 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS-WMG |
| 4 | 867633 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
| 5 | P00468815 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 6 | 1530252 | OTHER | PENNSYLVANIA | GATEWAY-WMG |
| 7 | 243488 | OTHER | PENNSYLVANIA | UNISON-WMG |
| 8 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
| 9 | 7184446 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
| 10 | 0019234200004 | MEDICAID | PENNSYLVANIA | |
| 11 | 1149404 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 12 | 120420410 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
| 13 | 1436398 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 14 | 25-1716306 | OTHER | PENNSYLVANIA | INFORMED |
| 15 | 25-1716306 | OTHER | PENNSYLVANIA | GREATWEST |
| 16 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
| 17 | 1839596 | OTHER | PENNSYLVANIA | AETNA HMO |
| 18 | 20090429 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY-WMG |
| 19 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |
| 20 | 25-1716306 | OTHER | PENNSYLVANIA | MULTIPLAN/PHCS |
| 21 | 928593-02 | OTHER | MARYLAND | CAREFIRST MD BCBS |
| 22 | 1530252 | OTHER | PENNSYLVANIA | GATEWAY |
| 23 | 018514100 | MEDICAID | MARYLAND | |
| 24 | 211698 | OTHER | PENNSYLVANIA | JOHNS HOPKINS |
| 25 | 234629 | OTHER | PENNSYLVANIA | UNISON (HFC) |
| 26 | 783867 | OTHER | PENNSYLVANIA | HEALTH AMERICA |
| 27 | 2183752 | OTHER | PENNSYLVANIA | MAMSI |
| 28 | 3395 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 29 | 50075853 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS |
| 30 | G920-0082/KDM4CU | OTHER | PENNSYLVANIA | CAREFIRST |
| 31 | MD420611 | OTHER | PENNSYLVANIA | MEDICAL LICENSE |