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 | | | | 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 | 0004053128 | OTHER | MARYLAND | AETNA HMO |
| 2 | 0506452 | OTHER | MARYLAND | AETNA PPO |
| 3 | 12070001 | OTHER | DISTRICT OF COLUMBIA | CARE FIRST BCBS OF DC REGION (GHMSI, BLUE CHOICE, BLUE PREFERRED, FEDERAL PLAN) |
| 4 | 43QMBK | OTHER | MARYLAND | CARE FIRST BCBS (NASCO) |
| 5 | 76630 | OTHER | MARYLAND | AMERIGROUP |
| 6 | 1383592 | OTHER | MARYLAND | CIGNA |
| 7 | 299998 | OTHER | MARYLAND | ANTHEM HEALTHKEEPER BLUE CROSS BLUE SHIELD |
| 8 | ========= | OTHER | MARYLAND | UNITED HEALTHCARE |
| 9 | 43QMBK | OTHER | MARYLAND | CARE FIRST INDIVIDUAL PLAN |
| 10 | 488178 | OTHER | MARYLAND | NCPP |
| 11 | 2165925 | OTHER | MARYLAND | ALLIANCE (PRIMARY PHYSICIAN) |
| 12 | 3165925 | OTHER | MARYLAND | ACCUPUNTURE SPECIALIST (ALLIANCE, OPTIMUM CHOICE, MAMSI, M.D.I.PA) |
| 13 | 796421800 | MEDICAID | MARYLAND | |
| 14 | 011496600 | MEDICAID | DISTRICT OF COLUMBIA | |
| 15 | ========= | OTHER | MARYLAND | TRICARE OF NORTH REGION |
| 16 | 8165925 | OTHER | MARYLAND | OPTIMUM CHOICE,MAMSI, M.D. IPA (PRIMARY PHYSICIAN) |
| 17 | 299996 | OTHER | VIRGINIA | ANTHEMHEALTH KEEPER VA |
| 18 | 41673501 | OTHER | MARYLAND | RANDERING NUMBER OF CARE FIRST BLUE CROSS OF MARYLAND |
| 19 | C61864 | MEDICARE UPIN | DISTRICT OF COLUMBIA | |
| 20 | 0100352 | OTHER | MARYLAND | AMERICHOICE |
| 21 | 0101397 | OTHER | MARYLAND | EVERCARE |
| 22 | 110005885 | OTHER | MARYLAND | RAILROAD MEDICARE PALMETTO GBA |
| 23 | 132214 | MEDICARE PIN | DISTRICT OF COLUMBIA | |
