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 | 213E00000X | Podiatrist | | 36-00-2444-S | OHIO | 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 | CI 5538 | OTHER | OHIO | RR MEDICARE GROUP BFAC |
| 2 | 0616263 BFAC | MEDICARE UPIN | OHIO | |
| 3 | 9247011 GROUP BFAC | MEDICARE UPIN | OHIO | |
| 4 | 0935322 | MEDICAID | OHIO | |
| 5 | H146290 | MEDICARE PIN | OHIO | |
| 6 | 480031326 | OTHER | OHIO | RAIL ROAD MEDICARE |
| 7 | CH 5179 | OTHER | OHIO | RR MEDICARE GROUP CFAC |
| 8 | 4310000001 | MEDICARE NSC | OHIO | |
| 9 | 0616264 | MEDICARE PIN | OHIO | |
| 10 | 480017770 | OTHER | OHIO | RR MEDICARE BFAC |
| 11 | 1131510004 | MEDICARE NSC | OHIO | |
| 12 | T80633 | MEDICARE UPIN | OHIO | |
| 13 | 9312431 GROUP CFAC | MEDICARE PIN | OHIO | |
