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 | A93398 | CALIFORNIA | Yes |
| 2 | 2085R0001X | Radiology | Radiation Oncology | 0101247041 | VIRGINIA | No |
| 3 | 2085R0001X | Radiology | Radiation Oncology | L-239140 | MASSACHUSETTS | No |
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 | PAR | OTHER | VIRGINIA | VA HEALTH NETWORK |
| 2 | 1629205190 | MEDICAID | VIRGINIA | |
| 3 | PAR | OTHER | VIRGINIA | CIGNA |
| 4 | PAR | OTHER | VIRGINIA | MULTIPLAN |
| 5 | PAR | OTHER | VIRGINIA | UNITED HEALTH CARE/MAMSI |
| 6 | 401737 | OTHER | VIRGINIA | ANTHEM BC/BS (GRESHAM DR.) |
| 7 | 401742 | OTHER | VIRGINIA | ANTHEM BC/BS (GLENN MITCHELL DR.) |
| 8 | PAR | OTHER | VIRGINIA | CORVEL/CORCARE |
| 9 | PAR | OTHER | VIRGINIA | AETNA |
| 10 | 5914173 | MEDICAID | NORTH CAROLINA | |
| 11 | VAA101148 | MEDICARE PIN | VIRGINIA | |
| 12 | 401734 | OTHER | VIRGINIA | ANTHEM BC/BS (FIRST COLONIAL RD) |
| 13 | PAR | OTHER | VIRGINIA | VA PREMIER HEALTH |
| 14 | 10059062 | OTHER | VIRGINIA | OPTIMA HEALTH |
| 15 | 1629205190 | OTHER | VIRGINIA | TRICARE |
| 16 | 401745 | OTHER | VIRGINIA | ANTHEM BC/BS (LAKE WRIGHT DR.) |
| 17 | PAR | OTHER | VIRGINIA | FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH |
| 18 | PAR | OTHER | VIRGINIA | USA MANAGED CARE |
