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 | 2085R0001X | Radiology | Radiation Oncology | 0101237252 | VIRGINIA | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | 24688 | WEST 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 | 9303191 | OTHER | WEST VIRGINIA | AETNA |
| 2 | P01001412 | OTHER | WEST VIRGINIA | RAILROAD MEDICARE |
| 3 | P01060034 | OTHER | WEST VIRGINIA | RAILROAD MEDICARE - WVRTSI |
| 4 | 006323C61 | MEDICARE PIN | VIRGINIA | |
| 5 | PAR | OTHER | VIRGINIA | USA MANAGED CARE (EVMS HEALTH SERVICES) |
| 6 | 10058965 | OTHER | VIRGINIA | OPTIMA HEALTH PLAN |
| 7 | PAR | OTHER | VIRGINIA | VA PREMIER HEALTH (EVMS HEALTH SERVICES) |
| 8 | PAR | OTHER | VIRGINIA | CIGNA |
| 9 | PAR | OTHER | VIRGINIA | FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH |
| 10 | PAR | OTHER | VIRGINIA | UNITED HEALTH CARE/MAMSI |
| 11 | 3810022555 | MEDICAID | WEST VIRGINIA | |
| 12 | 403901 | OTHER | VIRGINIA | ANTHEM BC/BS EVMS HEALTH SERVICES |
| 13 | WV1001A | MEDICARE PIN | WEST VIRGINIA | |
| 14 | 5914565 | MEDICAID | NORTH CAROLINA | |
| 15 | WV24688 | OTHER | WEST VIRGINIA | THE HEALTH PLAN OF THE UPPER OHIO VALLEY |
| 16 | 1609816214 | MEDICAID | VIRGINIA | |
| 17 | PAR | OTHER | VIRGINIA | TRICARE/CHAMPUS |
| 18 | I23670 | MEDICARE UPIN | VIRGINIA | |
| 19 | 403902 | OTHER | VIRGINIA | ANTHEM BC/BS EVMS HEALTH SERVICES |
| 20 | PAR | OTHER | VIRGINIA | MULTIPLAN (EVMS HEALTH SERVICES) |
| 21 | PAR | OTHER | VIRGINIA | AETNA |
| 22 | VAA101010 | MEDICARE PIN | VIRGINIA | |
| 23 | PAR | OTHER | VIRGINIA | VA HEALTH NETWORK |
| 24 | PAR | OTHER | VIRGINIA | CORVEL/CORCARE (EVMS HEALTH SERVICES) |
| 25 | VVA610C025 | MEDICARE PIN | VIRGINIA | |