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 | 207L00000X | Anesthesiology | | 11092 | NEW HAMPSHIRE | No |
| 2 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | 11092 | NEW HAMPSHIRE | No |
| 3 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | 2013-01844 | NORTH CAROLINA | No |
| 4 | 208VP0014X | Pain Medicine | Interventional Pain Medicine | MD 36305 | SOUTH CAROLINA | Yes |
| 5 | 207L00000X | Anesthesiology | | MD36605 | SOUTH CAROLINA | No |
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 | E70197 | MEDICARE UPIN | | |
| 2 | SC19175640 | MEDICARE PIN | SOUTH CAROLINA | |
| 3 | P01796495 | OTHER | SOUTH CAROLINA | RAILROAD MEDICARE |
| 4 | 363056 | MEDICAID | SOUTH CAROLINA | |
| 5 | NCG568A | MEDICARE PIN | NORTH CAROLINA | |
| 6 | RE6024 | MEDICARE PIN | NEW HAMPSHIRE | |
| 7 | SC1917665 | MEDICARE PIN | SOUTH CAROLINA | |
| 8 | 30201171 | MEDICAID | NEW HAMPSHIRE | |
| 9 | SC19177830 | MEDICARE PIN | SOUTH CAROLINA | |
