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 | 213E00000X | Podiatrist | | E6185 | CALIFORNIA | No |
| 2 | 213E00000X | Podiatrist | | SC004751L | PENNSYLVANIA | No |
| 3 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | E6185 | CALIFORNIA | 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 | 0029769 | OTHER | NEW JERSEY | NJ MEDICAL ASSISTANCE |
| 2 | 231365971 | OTHER | PENNSYLVANIA | HUMANA |
| 3 | 231365971071 | OTHER | PENNSYLVANIA | TRI-CARE |
| 4 | 1530858 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN PPO |
| 5 | 1969474 | MEDICAID | PENNSYLVANIA | |
| 6 | 3Y4987 | OTHER | PENNSYLVANIA | HEALTH NET |
| 7 | 436224 | OTHER | PENNSYLVANIA | HEALTH AMERICA HEALTH ASSURANCE |
| 8 | P3213656 | OTHER | PENNSYLVANIA | OXFORD |
| 9 | 0019694740002 | MEDICAID | PENNSYLVANIA | |
| 10 | 1092074 | OTHER | PENNSYLVANIA | AETNA HMO |
| 11 | 2216250000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN HMO |
| 12 | P12042552 | OTHER | PENNSYLVANIA | MULTI-PLAN |
| 13 | VL1530858 | OTHER | PENNSYLVANIA | BLUE SHIELD OF PA |
| 14 | 28824 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 15 | P00399669 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 16 | 2332158 | OTHER | PENNSYLVANIA | CIGNA |
| 17 | 7947715 | OTHER | PENNSYLVANIA | AETNA PPO |
| 18 | 13090 | OTHER | PENNSYLVANIA | ELDER HEALTH / BRAVO |
| 19 | 231365971 | OTHER | PENNSYLVANIA | UNITED HEALTH CARE |
| 20 | 30010156 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
