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 | 0102201931 | 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 | 068AY | OTHER | NORTH CAROLINA | BCBS OF NC |
| 2 | PAR | OTHER | VIRGINIA | CORVEL/CORCARE |
| 3 | 4165031 | OTHER | VIRGINIA | UHC/MAMSI (600 GRESHAM DR) |
| 4 | 011836C92 | MEDICARE PIN | VIRGINIA | |
| 5 | 165031 | OTHER | VIRGINIA | UNITEDHEALTHCARE/MAMSI,ET |
| 6 | PAR | OTHER | VIRGINIA | VIRGINIA PREMIER HEALTH (600 GRESHAM DR.) |
| 7 | H61616 | MEDICARE UPIN | | |
| 8 | 1629144894 | MEDICAID | VIRGINIA | |
| 9 | PAR | OTHER | VIRGINIA | MULTIPLAN (600 GRESHAM DR) |
| 10 | 10016803 | OTHER | VIRGINIA | OPTIMA/SENTARA |
| 11 | 268251 | OTHER | VIRGINIA | ANTHEM BCBS/HEALTHKEEPERS |
| 12 | VAA100630 | MEDICARE PIN | VIRGINIA | |
| 13 | 10033627 | OTHER | VIRGINIA | SENTARA/OPTIMA (600 GRESHAM DR) |
| 14 | 1101076 | OTHER | VIRGINIA | USA - 600 GRESHAM DR |
| 15 | 7542902 | OTHER | VIRGINIA | AETNA |
| 16 | P00402162 | MEDICARE PIN | VIRGINIA | |
| 17 | PAR | OTHER | VIRGINIA | FIRST HEALTH COMMERICAL/SOUTHERN HEALTH/COVENTRY |
| 18 | PAR | OTHER | VIRGINIA | VA HEALTH NETWORK (600 GRESHAM DR) |
| 19 | 353760 | OTHER | VIRGINIA | ANTHEM - 600 GRESHAM DRIVE |
| 20 | 6821081 | OTHER | VIRGINIA | CIGNA |
| 21 | 5906341 | MEDICAID | NORTH CAROLINA | |