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 | 2086S0105X | Surgery | Surgery of the Hand | 2007-00401 | NORTH CAROLINA | No |
| 2 | 2086S0122X | Surgery | Plastic and Reconstructive Surgery | 2007-00401 | NORTH CAROLINA | No |
| 3 | 2086S0122X | Surgery | Plastic and Reconstructive Surgery | 0101241162 | VIRGINIA | No |
| 4 | 208200000X | Plastic Surgery | | 0101241162 | VIRGINIA | No |
| 5 | 2082S0099X | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2007-00401 | NORTH CAROLINA | No |
| 6 | 2082S0099X | Plastic Surgery | Plastic Surgery Within the Head and Neck | 0101241162 | VIRGINIA | No |
| 7 | 208200000X | Plastic Surgery | | 2007-00401 | NORTH CAROLINA | 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 | 3810009016 | MEDICAID | WEST VIRGINIA | |
| 2 | 510I240012 | OTHER | ALABAMA | RAILROAD MEDICARE PTAN |
| 3 | 202030 | OTHER | | MEDCOST |
| 4 | 146F9 | OTHER | | BCBS |
| 5 | 810641 | OTHER | | PARTNERS |
| 6 | 9897073 | OTHER | | AETNA |
| 7 | 510I240012 | OTHER | ALABAMA | MEDICARE PTAN |
| 8 | 51595045 | OTHER | ALABAMA | BLUE CROSS BLUE SHIELD |
| 9 | 5906699 | MEDICAID | NORTH CAROLINA | |
| 10 | Q0040L | MEDICAID | SOUTH CAROLINA | |
