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 | 207Y00000X | Otolaryngology | | D0046383 | 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 | 148591100 793251101 | MEDICAID | MARYLAND | |
| 2 | F91641 | MEDICARE UPIN | MARYLAND | |
| 3 | 53302402 S186 | OTHER | MARYLAND | CAREFIRST BS IND & GRP |
| 4 | 2172963 | OTHER | MARYLAND | MAMSI |
| 5 | 50002834 GP 02426700 | OTHER | MARYLAND | CAPITAL BLUE CROSS |
| 6 | 516773 GRP 593934 | OTHER | PENNSYLVANIA | PA BS PA LOCATION |
| 7 | 0005 H883 | OTHER | MARYLAND | CAREFIRST REGIONAL NTWRK |
| 8 | 516615 GRP 59855 | OTHER | MARYLAND | PA BS MD LOCATION |
| 9 | LZ79 GRP S186 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | INDIV AND GROUP MEDICARE |
