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 | | 0101021602 | VIRGINIA | 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 | 0400438 | OTHER | VIRGINIA | UNITED HEALTH VIRGINIA |
| 2 | 110184237 | OTHER | VIRGINIA | RAILROAD MEDICARE |
| 3 | 257642 | OTHER | VIRGINIA | MDIPA/OPTIMUM CHOICE/MAMS |
| 4 | 4092013 | OTHER | VIRGINIA | AHP MGD CHOICE |
| 5 | 541908735 | OTHER | VIRGINIA | CCN |
| 6 | 5820308 | MEDICAID | VIRGINIA | |
| 7 | 224013 | OTHER | VIRGINIA | ANTHEM HEALTHKEEPERS |
| 8 | 505114 | OTHER | VIRGINIA | NCPPO |
| 9 | 461832 | OTHER | VIRGINIA | AETNA/US HEALTHCARE |
| 10 | 541908735 | OTHER | VIRGINIA | CHAMPUS/TRICARE/STANDARD |
| 11 | 000G43V39 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | MEDICARE |
| 12 | 541908735 | OTHER | VIRGINIA | PREFERRED PLAN |
| 13 | 0403501 | OTHER | VIRGINIA | UNITED HEALTH MID-ATLANTI |
| 14 | 541908735 | OTHER | VIRGINIA | PHCS |
| 15 | 723576 | OTHER | VIRGINIA | AFFORDABLE FIRST HEALTH |
| 16 | 224013 | OTHER | VIRGINIA | TRIGON KEYAD |
| 17 | 360386 | OTHER | VIRGINIA | ONE HEALTH GREATWEST |
| 18 | B93609 | MEDICARE UPIN | VIRGINIA | |
| 19 | 45560004 | OTHER | VIRGINIA | BCBS DC CAPCARE |
| 20 | 5325453-022 | OTHER | VIRGINIA | CIGNA HMO |
