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 | 207Q00000X | Family Medicine | | 34006186 | OHIO | No |
| 2 | 207Q00000X | Family Medicine | | 1439 | WEST VIRGINIA | 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 | 104698 | OTHER | PENNSYLVANIA | UPMC |
| 2 | 7716087001 | OTHER | | CIGNA |
| 3 | 4096162 | MEDICARE PIN | WEST VIRGINIA | |
| 4 | G01439A | OTHER | OHIO | THE HEALTH PLAN |
| 5 | 9359081 | MEDICARE PIN | OHIO | |
| 6 | 205314 | OTHER | | ADVANTRA FREEDOM |
| 7 | =========026 | OTHER | OHIO | CARESOURCE |
| 8 | 0242277 | MEDICAID | OHIO | |
| 9 | 3003385000 | MEDICAID | WEST VIRGINIA | |
| 10 | 000000117353 | OTHER | OHIO | THREE RIVERS PROV |
| 11 | =========00 | OTHER | OHIO | COMPMANAGEMENT |
| 12 | =========001 | OTHER | | TODAYS OPTION APP |
| 13 | 001705867 | OTHER | WEST VIRGINIA | MSBCBS |
| 14 | G01439A | OTHER | OHIO | MEDICARE PLUS HEALTHPLAN |
| 15 | 000000117353 | OTHER | | UNISOM HEALTH PLAN |
| 16 | 000000319438 | OTHER | OHIO | ANTHEM BCBS |
| 17 | 205314 | OTHER | | CARELINK |
| 18 | 205314 | OTHER | | HEALTH AMERICA |
| 19 | 205314 | OTHER | | CARELINK ADVANTRA |
| 20 | =========00 | OTHER | OHIO | WORKER'S COMPENSATION |
| 21 | =========001 | OTHER | OHIO | MEDICAL MUTUAL |
| 22 | DC8576 | OTHER | | RRW MEDICARE |
| 23 | 1060493 | OTHER | WEST VIRGINIA | WORKER'S COMPENSATION |
| 24 | 279582 | OTHER | | MAMSI |
| 25 | =========00 | OTHER | OHIO | 888 OHIOCOMP |
| 26 | G01439A | OTHER | OHIO | HEALTH PLAN MANAGED WORKER'S COMPENSATION PROGRAM |
| 27 | 205314 | OTHER | | HEALTH ASSURANCE |
| 28 | 001464699 | OTHER | PENNSYLVANIA | HIGHMARK BLUE CROSS |
