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 | 208800000X | Urology | | D0008736 | 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 | V746 0014 | OTHER | DISTRICT OF COLUMBIA | BSDC |
| 2 | V746 0014 | OTHER | MARYLAND | BSMD |
| 3 | 0715414 | OTHER | MARYLAND | CIGNA PROVIDER NUMBER |
| 4 | 017549E78 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | |
| 5 | 312564 | OTHER | MARYLAND | OPTIMUM CHOICE PROVIDER # |
| 6 | B92878 | MEDICARE UPIN | MARYLAND | |
| 7 | 312564 | OTHER | MARYLAND | MAMSI PROVIDER NUMBER |
| 8 | 312564 | OTHER | MARYLAND | MDIPA PROVIDER NUMBER |
| 9 | 312564 | OTHER | MARYLAND | ALLIANCE PROVIDER NUMBER |
| 10 | 521186611 | OTHER | MARYLAND | UNITED HEALTHCARE PROV # |
