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 | 208600000X | Surgery | | E7655 | ARKANSAS | 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 | 718333 | OTHER | MARYLAND | NCPPO/UNICARE |
| 2 | G01981G01 | MEDICARE PIN | MARYLAND | |
| 3 | G0198G01 | MEDICARE PIN | MARYLAND | |
| 4 | 21849 | OTHER | MARYLAND | CIGNA |
| 5 | 826A | OTHER | MARYLAND | CAREFIRST CAPTIAL CARE BC |
| 6 | G01981G01 | OTHER | MARYLAND | MARYLAND MEDICARE |
| 7 | G72912 | MEDICARE UPIN | MARYLAND | |
| 8 | 036474600 | MEDICAID | DISTRICT OF COLUMBIA | |
| 9 | 00X661I01 | MEDICARE PIN | VIRGINIA | |
| 10 | 66171 | OTHER | MARYLAND | CARENET |
| 11 | 826A | OTHER | MARYLAND | MARYLAND BC/BS |
| 12 | J740-001 | OTHER | MARYLAND | CAREFIRST BC/BS |
| 13 | 036747600 | MEDICAID | DISTRICT OF COLUMBIA | |
| 14 | 0001 | OTHER | MARYLAND | CAREFIRST BLUE CHOICE |
| 15 | 208292 | OTHER | VIRGINIA | BCBS OF VIRGINIA |
| 16 | 5396573 | OTHER | MARYLAND | AETNA PPO |
| 17 | 731696432 | OTHER | MARYLAND | AMERIGROUP |
| 18 | 731696432 | OTHER | MARYLAND | NCPPO |
| 19 | 826AGA | OTHER | MARYLAND | OPTIMA HEALTH |
| 20 | 3640878 | OTHER | MARYLAND | AETNA |
| 21 | 010367832 | OTHER | VIRGINIA | VIRGINIA PREMIER |
| 22 | 458642 | OTHER | MARYLAND | MAMSI |
| 23 | 105656 | OTHER | MARYLAND | ANTHEM BC/BS |
| 24 | 208292 | OTHER | VIRGINIA | HEALTH KEEPERS |
| 25 | 448205 | OTHER | MARYLAND | SOUTHERN HEALTH SERVICES |
| 26 | 010367832 | MEDICAID | VIRGINIA | |
| 27 | P00607603 | MEDICARE PIN | VIRGINIA | |
| 28 | 105657 | OTHER | DISTRICT OF COLUMBIA | ANTHEM BC/BC |
| 29 | 1014600 | MEDICAID | MARYLAND | |