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 | 207L00000X | Anesthesiology | | | | 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 | 0004347 | OTHER | PENNSYLVANIA | AETNA HMO |
| 2 | 33029 | OTHER | PENNSYLVANIA | HORIZON MERCY |
| 3 | 172813 | OTHER | PENNSYLVANIA | BLUE CHOICE |
| 4 | 33028 | OTHER | PENNSYLVANIA | KEYSTONE MERCY |
| 5 | 0022351000 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY |
| 6 | 172813 | OTHER | PENNSYLVANIA | PERSONAL CHOICE |
| 7 | 172813 | OTHER | PENNSYLVANIA | PA BLUE SHIELD |
| 8 | 3Y2278 | OTHER | PALAU | HEALTH NET |
| 9 | A645008 | OTHER | PENNSYLVANIA | OXFORD |
| 10 | CA5687 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 11 | 0022351000 | OTHER | PENNSYLVANIA | KHPE |
| 12 | ========= | OTHER | PENNSYLVANIA | QUALCARE |
| 13 | 1171914 | OTHER | NEW JERSEY | AETNA NJ |
| 14 | ========= | OTHER | PENNSYLVANIA | FIRST MCO |
| 15 | DA7311 | OTHER | NEW JERSEY | RAILROAD MEDICARE |
| 16 | ========= | OTHER | NEW JERSEY | FIRST MCO |
| 17 | DB0245 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 18 | 50001823 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 19 | ========= | OTHER | PENNSYLVANIA | DEVON |
| 20 | ========= | OTHER | PENNSYLVANIA | HEALTH ASS./HEALTH AM. |
| 21 | ========= | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |