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 | | 48304 | ARIZONA | No |
| 2 | 207Q00000X | Family Medicine | | 10892 | NEW HAMPSHIRE | No |
| 3 | 207Q00000X | Family Medicine | | MD056517L | PENNSYLVANIA | No |
| 4 | 207Q00000X | Family Medicine | | 335159 | NEW YORK | 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 | 01YP02430NH01 | OTHER | NEW HAMPSHIRE | ANETHEM ID# |
| 2 | 080186867 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE ID |
| 3 | 3017025 | OTHER | NEW HAMPSHIRE | AETNA ID# |
| 4 | P023475 | OTHER | PENNSYLVANIA | GATEWAY |
| 5 | 12561940 | OTHER | PENNSYLVANIA | MULTIPLAN |
| 6 | 222594672 | OTHER | NEW HAMPSHIRE | UNITED HEALTHCARE ID |
| 7 | 222594672 | OTHER | NEW HAMPSHIRE | TRICARE ID |
| 8 | 2248512 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 9 | 30200740 | MEDICAID | NEW HAMPSHIRE | |
| 10 | QZZ000000208841 | OTHER | PENNSYLVANIA | AETNA BETTER HEALTH |
| 11 | 222594672 | OTHER | NEW HAMPSHIRE | HEALTHCARE VALUE MANAGE# |
| 12 | 35973 | OTHER | NEW HAMPSHIRE | CIGNA ID# |
| 13 | 888567 | OTHER | PENNSYLVANIA | UPMC |
| 14 | 713530 | OTHER | NEW HAMPSHIRE | HARVARD PILGRIM ID# |
| 15 | 7599428 | OTHER | PENNSYLVANIA | AETNA |
| 16 | 2547667 | OTHER | PENNSYLVANIA | CIGNA |
| 17 | 222594672 | OTHER | NEW HAMPSHIRE | GREATWEST HEALTHCARE |
| 18 | 003607668 | OTHER | PENNSYLVANIA | HIGHMARK |
| 19 | 103284080 | MEDICAID | PENNSYLVANIA | |
| 20 | 30703781 | OTHER | PENNSYLVANIA | AMERIHEALTH CARITAS & VIP |
| 21 | 371509 | OTHER | NEW HAMPSHIRE | MVP ID# |
| 22 | 578117NWB | OTHER | PENNSYLVANIA | MEDICARE |
| 23 | 222594672 | OTHER | NEW HAMPSHIRE | PRIVATE HEALTHCARE ID |
