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 | 207RC0200X | Internal Medicine | Critical Care Medicine | D0058297 | MARYLAND | 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 | 691L F947 | MEDICARE PIN | MARYLAND | |
| 2 | P00917213 | OTHER | MARYLAND | MEDICARE RAILROAD |
| 3 | CL4599 P00020819 | OTHER | MARYLAND | RR MEDICARE |
| 4 | KJ86AN 61640302 | OTHER | MARYLAND | CAREFIRST BCBS |
| 5 | S352 S352 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BCBS |
| 6 | H55307 | MEDICARE UPIN | MARYLAND | |
| 7 | 269900101 370070400 | MEDICAID | MARYLAND | |