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 | 208M00000X | Hospitalist | | MD22414 | MAINE | 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 | 8127032 | OTHER | MARYLAND | MAMSI PROVIDE NUMBER |
| 2 | 521186611 | OTHER | MARYLAND | UNITED HEALTHCARE PROV # |
| 3 | 1012963 | OTHER | MARYLAND | CIGNA PROVIDER NUMBER |
| 4 | 431791201 | MEDICAID | MARYLAND | |
| 5 | 4328547 | OTHER | MARYLAND | AETNAPPO PROVIDER NUMBER |
| 6 | 61947103 | OTHER | MARYLAND | BSMD PROVIDER NUMBER |
| 7 | 8127032 | OTHER | MARYLAND | OPTIMUM CHOICE PROVIDER # |
| 8 | 4328547 | OTHER | MARYLAND | AETNA HMO PROVIDER NUMBER |
| 9 | 8127032 | OTHER | MARYLAND | ALLIANCE PROVIDER NUMBER |
| 10 | 9070 0020 | OTHER | MARYLAND | BSDC PROVIDER NUMBER |
| 11 | P16984 | OTHER | MARYLAND | CAREFIRST POS PROVIDER # |
| 12 | 8127032 | OTHER | MARYLAND | MDIPA PROVIDER NUMBER |
