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 | 207R00000X | Internal Medicine | | 28346 | NORTH CAROLINA | No |
| 2 | 207R00000X | Internal Medicine | | 14424 | SOUTH CAROLINA | No |
| 3 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 14424 | SOUTH CAROLINA | No |
| 4 | 207RI0011X | Internal Medicine | Interventional Cardiology | 28346 | NORTH CAROLINA | No |
| 5 | 207RI0011X | Internal Medicine | Interventional Cardiology | 14424 | SOUTH CAROLINA | No |
| 6 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 28346 | 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 | 210448J | MEDICARE PIN | NORTH CAROLINA | |
| 2 | N28346 | MEDICAID | SOUTH CAROLINA | |
| 3 | P00205957 | OTHER | | RAILROAD MEDICARE |
| 4 | A50542 | MEDICARE UPIN | | |
| 5 | 8976354 | MEDICAID | NORTH CAROLINA | |
| 6 | 76354 | OTHER | NORTH CAROLINA | BCBS |
