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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 2 | 207R00000X | Internal Medicine | | | | No |
| 3 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | | | No |
| 4 | 207RG0100X | Internal Medicine | Gastroenterology | | | No |
| 5 | 207RG0300X | Internal Medicine | Geriatric Medicine | | | No |
| 6 | 207RH0003X | Internal Medicine | Hematology & Oncology | | | No |
| 7 | 207RI0200X | Internal Medicine | Infectious Disease | | | No |
| 8 | 207RN0300X | Internal Medicine | Nephrology | | | No |
| 9 | 207RC0200X | Internal Medicine | Critical Care Medicine | | | No |
| 10 | 207RR0500X | Internal Medicine | Rheumatology | | | No |
| 11 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 12 | 163WC3500X | Registered Nurse | Cardiac Rehabilitation | | | No |
| 13 | 163WG0100X | Registered Nurse | Gastroenterology | | | No |
| 14 | 364SG0600X | Clinical Nurse Specialist | Gerontology | | | No |
| 15 | 364SX0200X | Clinical Nurse Specialist | Oncology | | | 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 | 0583337 | MEDICAID | OHIO | |
| 2 | CE0024 | OTHER | OHIO | RAILROAD MEDICARE |
