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 | 207QG0300X | Family Medicine | Geriatric Medicine | MD037437 | PENNSYLVANIA | 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 | P00774663 | OTHER | PENNSYLVANIA | RR MEDICARE - BUCKS |
| 2 | C32410 | MEDICARE UPIN | PENNSYLVANIA | |
| 3 | P00789459 | OTHER | PENNSYLVANIA | RR MEDICARE |
| 4 | 100746243 0004 | MEDICAID | PENNSYLVANIA | |
| 5 | 0739380000 | OTHER | PENNSYLVANIA | KEYSTONE HEALTH PLAN EAST |
| 6 | 1280437 | MEDICAID | PENNSYLVANIA | |
| 7 | 544102ZCHM | MEDICARE PIN | PENNSYLVANIA | |
| 8 | 30060281 | OTHER | PENNSYLVANIA | KEYSTONE MERCY-LOWER BUCKS GROUP |
| 9 | 544102 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 10 | 544102ZDKT | MEDICARE PIN | PENNSYLVANIA | |
| 11 | 30060281 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 12 | PA544102 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
