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 | 2085R0001X | Radiology | Radiation Oncology | MD30213 | DISTRICT OF COLUMBIA | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | C1-0004342 | DELAWARE | No |
| 3 | 2085R0001X | Radiology | Radiation Oncology | 0101050198 | VIRGINIA | No |
| 4 | 2085R0001X | Radiology | Radiation Oncology | D0051022 | MARYLAND | 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 | 9059699 | OTHER | MARYLAND | PHCS |
| 2 | 2257233 | OTHER | MARYLAND | AETNA HMO |
| 3 | 4582 | OTHER | MARYLAND | ELDER HEALTH |
| 4 | 112507900 | MEDICAID | MARYLAND | |
| 5 | 210940 | OTHER | MARYLAND | MAMSI |
| 6 | 7475033 | OTHER | MARYLAND | AETNA PPO/POS |
| 7 | 29020007 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BC/BS |
| 8 | 497792 | OTHER | DISTRICT OF COLUMBIA | NATIONAL CAPITOL PPO |
| 9 | F69169 | MEDICARE UPIN | | |
| 10 | 905LF181 | MEDICARE PIN | MARYLAND | |
| 11 | 003778S29 | MEDICARE PIN | MARYLAND | |
| 12 | 2130465 04 | OTHER | MARYLAND | UNITED HC/AMERICHOICE |
| 13 | 1728655 | OTHER | MARYLAND | FIRST HEALTH/CCN |
| 14 | 920004784 | MEDICARE PIN | MARYLAND | |
| 15 | 12665 | OTHER | MARYLAND | JOHNS HOPKINS HEALTHCARE |
| 16 | 202365 | OTHER | MARYLAND | KAISER PERMANENTE |
| 17 | 90296 | OTHER | MARYLAND | AMERIGROUP |
| 18 | 2937104002 | OTHER | MARYLAND | CIGNA |
| 19 | 603327-03 | OTHER | MARYLAND | CAREFIRST BC/BS |
| 20 | 034432500 | MEDICAID | DISTRICT OF COLUMBIA | |
