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 | 207Q00000X | Family Medicine | | 34006186 | OHIO | No |
| 2 | 207Q00000X | Family Medicine | | 1439 | WEST VIRGINIA | 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 | 000000319438 | OTHER | OHIO | ANTHEM BCBS |
| 2 | 001705867 | OTHER | WEST VIRGINIA | MSBCBS |
| 3 | 02064370800 | OTHER | OHIO | COMPMANAGEMENT |
| 4 | 104698 | OTHER | PENNSYLVANIA | UPMC |
| 5 | 205314 | OTHER | | ADVANTRA FREEDOM |
| 6 | 205314 | OTHER | | CARELINK HEALTH PLANS |
| 7 | 66588 | OTHER | WEST VIRGINIA | CARELINK HEALTH PLANS |
| 8 | 3003385000 | MEDICAID | WEST VIRGINIA | |
| 9 | 020643708001 | OTHER | OHIO | MEDICAL MUTUAL |
| 10 | WV9999 | OTHER | | MUTUAL OF OMAHA COMPANIES |
| 11 | 001464699 | OTHER | PENNSYLVANIA | BLUE SHIELD |
| 12 | 0206437080001 | OTHER | | CIGNA |
| 13 | 279582 | OTHER | | MAMSI |
| 14 | G01439A | OTHER | OHIO | HEALTH PLAN MANAGED WORKER'S |
| 15 | 4096163 | MEDICARE PIN | OHIO | |
| 16 | 000000117353 | OTHER | OHIO | THREE RIVERS PROV |
| 17 | 000000117353 | OTHER | OHIO | UNISON HEALTH PLAN |
| 18 | 02064370800 | OTHER | OHIO | 1-888-OHIO COMP |
| 19 | 0242277 | MEDICAID | OHIO | |
| 20 | 001464699 | OTHER | PENNSYLVANIA | HIGHMARK BLUE CROSS |
| 21 | 02064370800 | OTHER | OHIO | MANAGED MEDICAL ASSURANCE |
| 22 | 1060493 | OTHER | WEST VIRGINIA | SEDGWICK CLAIMS MANAGEMENT SERVICES, INC. |
| 23 | 1509863 | OTHER | PENNSYLVANIA | GATEWAY HEALTH PLAN |
| 24 | 4096162 | MEDICARE PIN | WEST VIRGINIA | |
| 25 | 000000667A | OTHER | | UPMC |
| 26 | 001705867 | OTHER | WEST VIRGINIA | BLUE SHIELD |
| 27 | 020643708 A01 | OTHER | OHIO | MEDICAL MUTUAL |
| 28 | 104698 | OTHER | | UPMC |
| 29 | 02064370800 | OTHER | OHIO | WORKER'S COMPENSATION |
| 30 | 02064370800 | OTHER | OHIO | COMPMANAGEMENT HEALTH SYSTEM |
| 31 | 080191603 | OTHER | | RRW MEDICARE |
| 32 | G01439A | OTHER | | THE HEALTH PLAN |
| 33 | 020643708 | OTHER | WEST VIRGINIA | WORKER'S COMPENSATION |
