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 | 207RI0200X | Internal Medicine | Infectious Disease | 0101241825 | VIRGINIA | 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 | 407305 | OTHER | VIRGINIA | ANTHEM BC/BS |
| 2 | PAR | OTHER | VIRGINIA | AETNA |
| 3 | 5914144 | MEDICAID | NORTH CAROLINA | |
| 4 | -032 | OTHER | VIRGINIA | TRICARE/CHAMPUS |
| 5 | PAR | OTHER | VIRGINIA | MULTIPLAN (EVMS HEALTH SERVICES) |
| 6 | 10060443 | OTHER | VIRGINIA | OPTIMA HEALTH |
| 7 | PAR | OTHER | VIRGINIA | VA HEALTH NETWORK |
| 8 | PAR | OTHER | VIRGINIA | CIGNA |
| 9 | PAR | OTHER | VIRGINIA | CORVEL/CORCARE (EVMS HEALTH SERVICES) |
| 10 | PAR | OTHER | VIRGINIA | USA MANAGED CARE (EVMS HEALTH SERVICES) |
| 11 | 1538141940 | MEDICAID | VIRGINIA | |
| 12 | VAA101008 | MEDICARE PIN | VIRGINIA | |
| 13 | PAR | OTHER | VIRGINIA | FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH |
| 14 | P00874027 | MEDICARE PIN | VIRGINIA | |
| 15 | PAR | OTHER | VIRGINIA | UNITED HEALTH CARE/MAMSI |
| 16 | PAR | OTHER | VIRGINIA | VA PREMIER HEALTH (EVMS HEALTH SERVICES) |
