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 | 207LP2900X | Anesthesiology | Pain Medicine | D0043021 | MARYLAND | No |
| 2 | 207L00000X | Anesthesiology | | D0043021 | 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 | F68652 | MEDICARE UPIN | | |
| 2 | 00B122C47 | MEDICARE PIN | DISTRICT OF COLUMBIA | |
| 3 | 086451000 | MEDICAID | MARYLAND | |
| 4 | 1619157 | OTHER | MARYLAND | FIRST HEALTH |
| 5 | 5263677 | OTHER | MARSHALL ISLANDS | CCN FH |
| 6 | 159328Y2M | MEDICARE PIN | MARYLAND | |
| 7 | 5608478 | OTHER | MARYLAND | AETNA US HEALTH CARE PPO |
| 8 | KBC1CH | OTHER | MARYLAND | CAREFIRST BCBS |
| 9 | 0001 GRP S417 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BC BS OF DC |
| 10 | 2961252 | OTHER | MARYLAND | AETNA US HEALTH CARE HMO |
| 11 | 050087029 | OTHER | MARYLAND | RR MEDICARE |