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 | 208100000X | Physical Medicine & Rehabilitation | | MD419657 | 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 | 0019034540003 | MEDICAID | PENNSYLVANIA | |
| 2 | 0208746000 | OTHER | | INDEPENDENCE BLUE CROSS |
| 3 | 9244337 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 50011845 | OTHER | | KEYSTONE HEALTH CENTRAL |
| 5 | 821137 | OTHER | | FIRST PRIORITY HEALTH |
| 6 | 2150109 | OTHER | | UNITED HEALTHCARE |
| 7 | 260051063 | OTHER | | RAILROAD MEDICARE |
| 8 | 0208746000 | OTHER | | AMERIHEALTH |
| 9 | 2170565 | OTHER | | MAMSI |
| 10 | H31247 | MEDICARE UPIN | PENNSYLVANIA | |
| 11 | P3159655 | OTHER | | OXFORD HEALTH PLANS |
| 12 | 0208746000 | OTHER | | KEYSTONE HEALTH EAST |
| 13 | 1398626 | OTHER | | HIGHMARK BLUE SHIELD |
| 14 | 50011845 | OTHER | | CAPITAL BLUE CROSS |
| 15 | 3001265 | OTHER | | AETNA PPO |
| 16 | 3286904 | OTHER | | HEALTH AMERICA/HEALTH ASS |
| 17 | 75928 | OTHER | | GEISINGER HEALTH PLAN |
| 18 | 062896 | MEDICARE PIN | | |
