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 | 207X00000X | Orthopaedic Surgery | | D32345 | 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 | 091051 | OTHER | VIRGINIA | TRIGON VA BCBS |
| 2 | 006476953 | MEDICAID | VIRGINIA | |
| 3 | 327279 | OTHER | | PRIME HEALTH |
| 4 | 0000187201 | MEDICAID | DELAWARE | |
| 5 | 0006W409 | OTHER | | BCBS PROD FEP BLUE CHOICE |
| 6 | 3226878 | OTHER | | AETNA |
| 7 | C57450 | MEDICARE UPIN | MARYLAND | |
| 8 | H524G552 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | |
| 9 | 66G39 | OTHER | | EMPIRE BCBS |
| 10 | 221921800 | OTHER | | US DEPARTMENT OF LABOR |
| 11 | 378481900 | MEDICAID | MARYLAND | |
| 12 | 41777101H524PE | OTHER | | BCBS TRAD PRODUCTS |
| 13 | NP0009 | OTHER | | FREESTATE DELMARVA HEALTH |
| 14 | 22856 | OTHER | MARYLAND | MDIPA OPTIMUM CHOICE |
| 15 | 200022314 | OTHER | | RAILROAD MEDICARE |
