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 | 2085R0001X | Radiology | Radiation Oncology | ME0026427 | FLORIDA | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | MD11285 | RHODE ISLAND | Yes |
| 3 | 2085R0001X | Radiology | Radiation Oncology | G26661 | CALIFORNIA | No |
| 4 | 2085R0001X | Radiology | Radiation Oncology | 4877 | NEVADA | No |
| 5 | 2085R0001X | Radiology | Radiation Oncology | 2001-01567 | NORTH CAROLINA | No |
| 6 | 2085R0203X | Radiology | Therapeutic Radiology | ME26427 | FLORIDA | No |
| 7 | 2085R0001X | Radiology | Radiation Oncology | 127667-1 | NEW YORK | No |
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 | 4129712 | OTHER | FLORIDA | AETNA PROVIDER NUMBER |
| 2 | 592485899 | OTHER | FLORIDA | METCARE VENDOR ID # |
| 3 | 00787 | OTHER | FLORIDA | UNV. HLTHCR. PROVIDER # |
| 4 | 01738807 | MEDICAID | NEW YORK | |
| 5 | 205786 | OTHER | FLORIDA | AVMED PROVIDER NUMBER |
| 6 | MB505 | OTHER | FLORIDA | MEDICARE |
| 7 | MB506 | OTHER | FLORIDA | MEDICARE |
| 8 | 24-05164 | OTHER | FLORIDA | UTD. HLTHCR. PROVIDER # |
| 9 | 0916153-016 | OTHER | FLORIDA | CIGNA PROVIDER NUMBER |
| 10 | MD11285 | OTHER | RHODE ISLAND | LICENSE |
| 11 | 00G26610 | MEDICAID | CALIFORNIA | |
| 12 | 065594500 | MEDICAID | FLORIDA | |
| 13 | 76715 | OTHER | FLORIDA | OP. ENG. LOC. 825 PROV. # |
| 14 | 985684 | OTHER | FLORIDA | WELLCARE |
| 15 | 2019966 | MEDICAID | NEVADA | |
