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 | | | | 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 | 2131125 | OTHER | MARYLAND | MAMSI PROVIDER NUMBER |
| 2 | J6860006 | OTHER | MARSHALL ISLANDS | CAREFIRST BCBS OF DC PROV |
| 3 | 5353197 | OTHER | MARSHALL ISLANDS | AETNA PPO PROVIDER NUMBER |
| 4 | G42676 | MEDICARE UPIN | MARYLAND | |
| 5 | 1622878 | OTHER | MARYLAND | UNITED HEALTHCARE PROVIDE |
| 6 | 9002247 | OTHER | MARYLAND | PRIVATE HEALTHCARE SYSTEM |
| 7 | 520689917 | OTHER | MARYLAND | TAX ID NUMBER |
| 8 | 645177-01 | OTHER | MARYLAND | CAREFIRST BCBS OF MD PROV |
| 9 | 1303080 | OTHER | MARYLAND | CIGNA PROVIDER NUMBER |
| 10 | 33525 | OTHER | MARYLAND | JOHN HOPKINS HEALTH CARE |
| 11 | 165725ZEZJ | MEDICARE PIN | MARYLAND | |
| 12 | DD8312 | OTHER | MARYLAND | MEDICARE RAILROAD |
| 13 | 3767375 | OTHER | MARYLAND | AETNA HMO PROVIDER NUMBER |
| 14 | 704197 | OTHER | MARYLAND | NCPPO PROVIDER NUMBER |
| 15 | 406923400 | MEDICAID | MARYLAND | |
