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 | 207X00000X | Orthopaedic Surgery | | 35365 | 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 | 9016 | OTHER | | PARTNERS MEDICARE |
| 2 | 2069444 | OTHER | | AETNA US HEALTHCARE |
| 3 | 41321 | OTHER | | BCBS OF NC |
| 4 | 2173069 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | |
| 5 | 1576561005 | OTHER | | CIGNA HEALTHCARE |
| 6 | 4253484 | OTHER | | AETNA HMO PPO |
| 7 | 340645 | OTHER | | ONE HEALTH PLAN |
| 8 | 200036694 | OTHER | | RAILROAD MEDICARE |
| 9 | 8941321 | MEDICAID | NORTH CAROLINA | |
| 10 | 2173069A | MEDICARE PIN | NORTH CAROLINA | |
| 11 | 530003 | OTHER | | PRINCIPAL HEALTHCARE |
| 12 | 45728 | OTHER | | MEDCOST |
| 13 | Q35365 | MEDICAID | SOUTH CAROLINA | |
| 14 | 0941551 | OTHER | | UNITED HEALTHCARE |
| 15 | E01354 | MEDICARE UPIN | | |
