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 | 213E00000X | Podiatrist | | P0478 | DISTRICT OF COLUMBIA | 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 | 12107 | OTHER | DISTRICT OF COLUMBIA | CHARTERED HEALTH PLAN |
| 2 | ========= | OTHER | DISTRICT OF COLUMBIA | ONENET PPO |
| 3 | ========= | OTHER | DISTRICT OF COLUMBIA | CIGNA HEALTH CARE |
| 4 | ========= | OTHER | DISTRICT OF COLUMBIA | COVENTRY HEALTH CARE NET. |
| 5 | 000594594 | OTHER | DISTRICT OF COLUMBIA | APWU |
| 6 | 4151 | OTHER | DISTRICT OF COLUMBIA | BLUE CROSS BLUE SHIELD |
| 7 | ========= | OTHER | DISTRICT OF COLUMBIA | UNITED HEALTH CARE |
| 8 | 026584500 | MEDICAID | DISTRICT OF COLUMBIA | |
| 9 | ========= | OTHER | DISTRICT OF COLUMBIA | EIN # |
| 10 | 246484MD2 | OTHER | DISTRICT OF COLUMBIA | M.D. IPA |
| 11 | ========= | OTHER | DISTRICT OF COLUMBIA | AETNA HEALTH PLAN |
| 12 | 08508 | OTHER | DISTRICT OF COLUMBIA | AMERIGROUP |
| 13 | ========= | OTHER | DISTRICT OF COLUMBIA | MAMSI |
