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 | 207Q00000X | Family Medicine | | | | No |
| 2 | 207R00000X | Internal Medicine | | | | No |
| 3 | 207RI0200X | Internal Medicine | Infectious Disease | | | No |
| 4 | 207V00000X | Obstetrics & Gynecology | | | | No |
| 5 | 208000000X | Pediatrics | | | | No |
| 6 | 261Q00000X | Clinic/Center | | | | Yes |
| 7 | 282N00000X | General Acute Care Hospital | | 250301 | PENNSYLVANIA | No |
| 8 | 363L00000X | Nurse Practitioner | | | | No |
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 | 20015753 | OTHER | PENNSYLVANIA | AMERIHEALTH INF DIS |
| 2 | 131294 | OTHER | PENNSYLVANIA | UNISON- INF DISEASE |
| 3 | 1525567 | OTHER | PENNSYLVANIA | GATEWAY INFECTI DIS |
| 4 | 20010017 | OTHER | PENNSYLVANIA | AMERIHEALTH M PEDSPCP |
| 5 | 7152889 | OTHER | PENNSYLVANIA | AETNA |
| 6 | CI1598 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 7 | 1146406 | OTHER | PENNSYLVANIA | AMERIHEALTH OBGYN |
| 8 | 1377972 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 9 | 20011313 | OTHER | PENNSYLVANIA | AMERIHEALTH FP |
| 10 | 02900700 | OTHER | PENNSYLVANIA | CAPITAL BC IM FP |
| 11 | 1145646 | OTHER | PENNSYLVANIA | AMERIHEALTH IM |
| 12 | 1522646 | OTHER | PENNSYLVANIA | GATEWAY PEDS PCP |
| 13 | S1FF | OTHER | PENNSYLVANIA | GEISINGER |
| 14 | 115898 | OTHER | PENNSYLVANIA | UNISON- OB/GYN |
| 15 | LT62 | OTHER | MARYLAND | CAREFIRST BCBS |
| 16 | 1001965470074 | MEDICAID | PENNSYLVANIA | |
| 17 | 1519306 | OTHER | PENNSYLVANIA | GATEWAY IM FP |
| 18 | 1545723 | OTHER | PENNSYLVANIA | GATEWAY PEDS SPEC |
| 19 | 20016311 | OTHER | PENNSYLVANIA | AMERIHEALTH PEDS |
| 20 | 328T | OTHER | PENNSYLVANIA | GEISINGER |
| 21 | 50047701 | OTHER | PENNSYLVANIA | CAPITAL BC PEDS |
| 22 | 50047702 | OTHER | PENNSYLVANIA | CAPITAL BC SPECIALISTS |
| 23 | 115914 | OTHER | PENNSYLVANIA | UNISON PCP |
| 24 | 1519818 | OTHER | PENNSYLVANIA | GATEWAY OBGYN |
