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 | | MD434774 | PENNSYLVANIA | No |
| 2 | 208M00000X | Hospitalist | | 25MA12304000 | NEW JERSEY | No |
| 3 | 208M00000X | Hospitalist | | MD434774 | 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 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |
| 2 | 1007307260034 | OTHER | PENNSYLVANIA | MEDICAID GROUP # |
| 3 | 1930607 | OTHER | PENNSYLVANIA | AETNA HMO |
| 4 | P00683490 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 5 | 9426191 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
| 6 | 1577284 | OTHER | PENNSYLVANIA | GATEWAY |
| 7 | 25-1716306 | OTHER | PENNSYLVANIA | MULTIPLAN/PHCS |
| 8 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
| 9 | 25-1716306 | OTHER | PENNSYLVANIA | GREATWEST HEALTHCARE |
| 10 | 867633 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
| 11 | MD434774 | OTHER | PENNSYLVANIA | PA MEDICAL LICENSE |
| 12 | 102173588 0001 | MEDICAID | PENNSYLVANIA | |
| 13 | 120420410 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
| 14 | 1497910202 | OTHER | PENNSYLVANIA | HEALTH AMERICA |
| 15 | 2182021 | OTHER | PENNSYLVANIA | MAMSI |
| 16 | 25-1716306 | OTHER | PENNSYLVANIA | SOUTH CENTRAL PREFERRED |
| 17 | 25-1716306 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 18 | 2060896 | OTHER | PENNSYLVANIA | HIGHMARK BLUESHIELD |
| 19 | G920-0099/KDM4CU | OTHER | PENNSYLVANIA | CAREFIRST |
| 20 | 248748 | OTHER | PENNSYLVANIA | UNISON |
| 21 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
| 22 | 25-1716306 | OTHER | PENNSYLVANIA | INFORMED |
| 23 | 50079008 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS |