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 | 174400000X | Specialist | | 9401129 | NORTH CAROLINA | 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 | 020023755 | OTHER | NORTH CAROLINA | RR MEDC PROVIDER NUMBER |
| 2 | 9047 | OTHER | NORTH CAROLINA | PARTNERS PROVIDER NUMBER |
| 3 | 15597 | OTHER | NORTH CAROLINA | BCBS PROVIDER NUMBER |
| 4 | 2073917 | OTHER | NORTH CAROLINA | 1ST HEALTH PROVIDER NUMBE |
| 5 | 4511801 | OTHER | NORTH CAROLINA | AETNA PROVIDER NUMBER |
| 6 | 8915597 | MEDICAID | NORTH CAROLINA | |
| 7 | F88261 | MEDICARE UPIN | NORTH CAROLINA | |
| 8 | 262706 | OTHER | NORTH CAROLINA | MAMSI PROVIDER NUMBER |
| 9 | 1266115 | OTHER | NORTH CAROLINA | UNITED PROVIDER NUMBER |
| 10 | 0925931 | OTHER | NORTH CAROLINA | AETNA HMO PROVIDER NUMBER |
| 11 | 901266 | OTHER | NORTH CAROLINA | BEECHSTREET/FOCUS PROVIDE |
| 12 | 7234797001 | OTHER | NORTH CAROLINA | CIGNA PROVIDER NUMBER |
| 13 | 2203016 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | |
| 14 | 234218 | OTHER | NORTH CAROLINA | PRIVATE HEALTH CARE SYS |
| 15 | 53518 | OTHER | NORTH CAROLINA | MEDCOST PROVIDER NUMBER |
