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 | 213E00000X | Podiatrist | | 36002143 | OHIO | No |
| 2 | 213E00000X | Podiatrist | | 0103000771 | 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 | 4204 | OTHER | | CARE FIRST BCBS |
| 2 | 226088 | OTHER | | HEALTHKEEPERS ANTHEM |
| 3 | 0576286 | OTHER | | AETNA HMO |
| 4 | 299447 | OTHER | VIRGINIA | ANTHEM |
| 5 | 311280402 | OTHER | | TRICARE TRICARE PRIME |
| 6 | 311280402 | OTHER | | NCPPO |
| 7 | 299434 | OTHER | VIRGINIA | ANTHEM |
| 8 | 0647020001 | MEDICARE NSC | VIRGINIA | |
| 9 | 311280402 | OTHER | | UNICARE NCPPO |
| 10 | 480029028 | MEDICARE PIN | DISTRICT OF COLUMBIA | |
| 11 | 0004509259 | OTHER | | AETNA PPO |
| 12 | 417278 | OTHER | VIRGINIA | ONE NET |
| 13 | 492234 | MEDICARE PIN | DISTRICT OF COLUMBIA | |
| 14 | 1858423 | OTHER | | CIGNA PPO |
| 15 | 0647020002 | MEDICARE NSC | DISTRICT OF COLUMBIA | |
| 16 | T93579 | MEDICARE UPIN | VIRGINIA | |
| 17 | 480000214 | MEDICARE PIN | VIRGINIA | |
| 18 | 480017779 | MEDICARE PIN | VIRGINIA | |
| 19 | 33004 | OTHER | | COMMUNITY CARE NTWK |
| 20 | 311280402 | OTHER | | MAILHANDLERS PPO |
