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 | 208800000X | Urology | | 21951 | WEST VIRGINIA | No |
| 2 | 208800000X | Urology | | 2010-01628 | NORTH CAROLINA | 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 | 3810003183 | MEDICAID | WEST VIRGINIA | |
| 2 | 328290 | OTHER | WEST VIRGINIA | CARELINK |
| 3 | 4508291 | OTHER | WEST VIRGINIA | AETNA |
| 4 | NC1335 | MEDICAID | SOUTH CAROLINA | |
| 5 | 000422674 | OTHER | WEST VIRGINIA | BC/BS |
| 6 | C62736 | MEDICARE UPIN | WEST VIRGINIA | |
| 7 | P00272622 | OTHER | WEST VIRGINIA | RAILROAD MEDICARE |
| 8 | 4167831 | MEDICARE ID-TYPE UNSPECIFIED | WEST VIRGINIA | |
| 9 | WV21951 | OTHER | WEST VIRGINIA | HEALTH PLAN |
| 10 | 2076856A | MEDICARE PIN | NORTH CAROLINA | |
| 11 | 2076856 | MEDICARE PIN | NORTH CAROLINA | |
| 12 | 5916118 | MEDICAID | NORTH CAROLINA | |
