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 | 213ES0131X | Podiatrist | Foot Surgery | SC-001976-L | PENNSYLVANIA | 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 | 338060 | OTHER | WASHINGTON | COMBINED INS CO |
| 2 | 001522 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 3 | 21298 | OTHER | PENNSYLVANIA | GEISSINGER HEALTH PLAN |
| 4 | 251363650 | OTHER | PENNSYLVANIA | PA EMPLOYES BENEFIT FUND |
| 5 | 480021319 | OTHER | SOUTH CAROLINA | RAILROAD MEDICARE |
| 6 | 0005070180003 | MEDICAID | PENNSYLVANIA | |
| 7 | 1295443 | OTHER | TEXAS | AAG BENEFIT PLAN ADMINIST |
| 8 | 251363650 | OTHER | GEORGIA | UNITED HEALTHCARE |
| 9 | 251363650 | OTHER | PENNSYLVANIA | STATE FARM HEALTH INS |
| 10 | 251363650 | OTHER | OHIO | UNITED COMMERICAL TRAVELE |
| 11 | 251363650 | OTHER | FLORIDA | GENWORTH FINANCIAL |
| 12 | 50001941 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 13 | 0004390700 | OTHER | TEXAS | AETNA |
| 14 | 251363650 | OTHER | PENNSYLVANIA | CIGNA |
| 15 | 335768 | OTHER | PENNSYLVANIA | HEALTH AMERICA |
| 16 | 1000010001251363650 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 17 | 251363650 | OTHER | PENNSYLVANIA | HOP ADMINISTRATION |
| 18 | 251363650 | OTHER | FLORIDA | AMERICAHGENERAL LIFE |
