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 | 174400000X | Specialist | | D0046908 | 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 | 3951050 | OTHER | MARYLAND | AETNA HMO |
| 2 | Y40622 | MEDICARE UPIN | MARYLAND | |
| 3 | 349576 | OTHER | MARYLAND | UNITED HEALTHCARE |
| 4 | G02088 | OTHER | DISTRICT OF COLUMBIA | MEDICARE OF DC |
| 5 | 6999637 | OTHER | MARYLAND | CIGNA |
| 6 | 930BEA | OTHER | MARYLAND | BLUE CROSS/BLUE SHIELD MD |
| 7 | 0001 | OTHER | DISTRICT OF COLUMBIA | BLUE CROSS/BLUE SHIELD DC |
| 8 | 247N | MEDICARE PIN | MARYLAND | |
| 9 | 61563304 | OTHER | MARYLAND | BLUE CROSS/BLUE SHIELD MD |
| 10 | 5384008 | OTHER | MARYLAND | AETNA PPO |
| 11 | K614 | OTHER | DISTRICT OF COLUMBIA | BLUE CROSS/BLUE SHIELD DC |
| 12 | G02088E01 | OTHER | DISTRICT OF COLUMBIA | MEDICARE OF DC |
