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 | 2085B0100X | Radiology | Body Imaging | 7489 | SOUTH CAROLINA | No |
| 2 | 2085D0003X | Radiology | Diagnostic Neuroimaging | 7489 | SOUTH CAROLINA | No |
| 3 | 2085H0002X | Radiology | Hospice and Palliative Medicine | 7489 | SOUTH CAROLINA | No |
| 4 | 2085N0700X | Radiology | Neuroradiology | 7489 | SOUTH CAROLINA | No |
| 5 | 2085N0904X | Radiology | Nuclear Radiology | 7489 | SOUTH CAROLINA | No |
| 6 | 2085N0904X | Radiology | Nuclear Radiology | 19641 | NORTH CAROLINA | No |
| 7 | 2085R0202X | Radiology | Diagnostic Radiology | 19641 | NORTH CAROLINA | No |
| 8 | 2085R0203X | Radiology | Therapeutic Radiology | 7489 | SOUTH CAROLINA | No |
| 9 | 2085R0203X | Radiology | Therapeutic Radiology | 19641 | NORTH CAROLINA | No |
| 10 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 7489 | SOUTH CAROLINA | No |
| 11 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 19641 | NORTH CAROLINA | No |
| 12 | 2085U0001X | Radiology | Diagnostic Ultrasound | 7489 | SOUTH CAROLINA | No |
| 13 | 2085U0001X | Radiology | Diagnostic Ultrasound | 19641 | NORTH CAROLINA | No |
| 14 | 2085R0202X | Radiology | Diagnostic Radiology | 7489 | SOUTH CAROLINA | 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 | D47042 | MEDICARE UPIN | SOUTH CAROLINA | |
| 2 | 891337U | MEDICAID | NORTH CAROLINA | |
| 3 | 3755 | MEDICARE ID-TYPE UNSPECIFIED | SOUTH CAROLINA | |
| 4 | 2019499 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | |
| 5 | 1337U | OTHER | NORTH CAROLINA | BCBS NC |
| 6 | 570919974 | OTHER | SOUTH CAROLINA | BCBS SC |
| 7 | 074895 | MEDICAID | SOUTH CAROLINA | |
