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 | 207RN0300X | Internal Medicine | Nephrology | D70833 | MARYLAND | 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 | 1649428897 | OTHER | | CIGNA |
| 2 | F117 AND 0J48PA | OTHER | | CAREFIRST BLUECROSS BLUESHIELD |
| 3 | 1649428897 | OTHER | | MULTIPLAN, PHCS |
| 4 | 1649428897 | OTHER | | COVENTRY HEALTH CARE OF DELAWARE |
| 5 | 01366238 | OTHER | | AMERIGROUP |
| 6 | 1649428897 | OTHER | | MARYLAND PHYSICIANS CARE |
| 7 | 418952301 | MEDICAID | MARYLAND | |
| 8 | 1649428897 | OTHER | | TRICARE |
| 9 | 522300606 | OTHER | MARYLAND | PATUXENT NEPHROLOGY ASSOCIATES, LLC |
| 10 | 1649428897 | OTHER | | CARE IMPROVEMENT PLUS |
| 11 | 1649428897 | OTHER | | KAISER PERMANENTE |
| 12 | 1649428897 | OTHER | | UNITED HEALTHCARE, MAMSI, MDIPA, OPTIMUM CHOICE |