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 | 207RP1001X | Internal Medicine | Pulmonary Disease | D0018779 | MARYLAND | No |
| 2 | 207R00000X | Internal Medicine | | D0018779 | 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 | T769 0001 | OTHER | | FEDERAL BCBS |
| 2 | 3725 | OTHER | | MEDSTAR FAMILLY CHOICE |
| 3 | D77824 | MEDICARE UPIN | | |
| 4 | 8401AS | MEDICARE PIN | | |
| 5 | 029023 | OTHER | | PRIORITY PARTNERS MCO |
| 6 | 2922 | OTHER | | COVENTRY HEALTHCARE |
| 7 | 41527 | OTHER | | COVENTRY DIAMOND PLAN |
| 8 | 0400703 | OTHER | | UNITED HEALTHCARE FAMILY FIRST |
| 9 | 455516 | OTHER | | AETNA US HEALTHCARE |
| 10 | T769 0001 | OTHER | | BLUE CHOICE CAREFIRST |
| 11 | 2796 | OTHER | | BRAVO HEALTH |
| 12 | 406291389 | OTHER | | MEDICARE RAILROAD |
| 13 | 8401AS | OTHER | | CAREFIRST BCBS |
| 14 | 843756 | OTHER | | MAMSI PLAN |
| 15 | 0400703 | OTHER | | UNITED HEALTHCARE |
| 16 | 088380000 | OTHER | | BLUE CROSS BLUE SHIELD PHN |
| 17 | 98453-02 | OTHER | | AMERIGROUP MARYLAND |
| 18 | 98453-01 | OTHER | | AMERIGROUP MARYLAND |
| 19 | 1158241 | OTHER | | CIGNA |
| 20 | 029023 | OTHER | | JOHNS HOPKINS HEALTHCARE |
| 21 | 9000437 | OTHER | | PRUDENTIAL |
| 22 | 250751000 | MEDICAID | MARYLAND | |
