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 | 332B00000X | Durable Medical Equipment & Medical Supplies | | 16166763 | MARYLAND | Yes |
| 2 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | No |
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 | 05005571 | OTHER | MARYLAND | AMERIGROUP |
| 2 | 444313600 | MEDICAID | MARYLAND | |
| 3 | DG60 | OTHER | MARYLAND | CAREFIRST BLUECHOICE |
| 4 | 5906592 | OTHER | | CIGNA |
| 5 | DG60 | OTHER | MARYLAND | CAREFIRST BLUECROSS BLUESHIELD |
| 6 | 2021218766 | MEDICAID | VIRGINIA | |
| 7 | 250694969 | MEDICAID | DELAWARE | |
| 8 | DG60 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST CHPDC |
| 9 | DM1697 | MEDICAID | SOUTH CAROLINA | |
| 10 | MDPRV00024017 | OTHER | MARYLAND | AETNA BETTER HEALTH |
| 11 | 05005571 | OTHER | DISTRICT OF COLUMBIA | AMERIGROUP |
| 12 | 60402094 | OTHER | DISTRICT OF COLUMBIA | AMERI HEALTH CARITAS DC |
| 13 | 060653859 | MEDICAID | DISTRICT OF COLUMBIA | |
| 14 | 10085097 | OTHER | DISTRICT OF COLUMBIA | MEDSTAR FAMILY CHOICE OF DC |
| 15 | 10085097 | OTHER | MARYLAND | MEDSTAR FAMILY CHOICE OF MD |
| 16 | PDXGR13328727 | OTHER | MARYLAND | AETNA BETTER HEALTH OF MD |
