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 | 83394-20 | WISCONSIN | Yes |
| 2 | 207R00000X | Internal Medicine | | 229632 | NEW YORK | No |
| 3 | 207RI0200X | Internal Medicine | Infectious Disease | 229632 | NEW YORK | No |
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 | 31967773 | OTHER | | CIGNA HEALTH CARE |
| 2 | NWH TAX ID | OTHER | | DEVON HEALTH GRP PIN# |
| 3 | NWH TAX ID | OTHER | | CHN SOLUTIONS -GRP PIN # |
| 4 | 0140665 | OTHER | | GHI PPO PROVIDER ID |
| 5 | NWH TAX ID | OTHER | | PHCS-PROVIDER ID |
| 6 | 10119993-U104 | OTHER | | CDPHP PROVIDER # &GRP # |
| 7 | 450AP1 | OTHER | | EMPIRE BC-BS |
| 8 | 7988846 | OTHER | | AETNA PROVIDER ID PPO |
| 9 | 000000114410 | OTHER | | GHI - HMO |
| 10 | 07020900104 | OTHER | | FIDELIS CARE OF NY |
| 11 | 1423323 | OTHER | | AETNA HMO |
| 12 | 396943 | OTHER | | MVP HEALTHPLAN |
| 13 | NWH TAX ID | OTHER | | BEECH STREET PROVIDER ID |
| 14 | NWH TAX ID | OTHER | | POMCO PROVIDER # |
| 15 | P003676971 | OTHER | | RAILROAD MEDICARE PIN# |
