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 | 101Y00000X | Counselor | | 25301 | PENNSYLVANIA | No |
| 2 | 101YA0400X | Counselor | Addiction (Substance Use Disorder) | 250301 | PENNSYLVANIA | No |
| 3 | 102L00000X | Psychoanalyst | | 250301 | PENNSYLVANIA | No |
| 4 | 207LP2900X | Anesthesiology | Pain Medicine | 250301 | PENNSYLVANIA | No |
| 5 | 207P00000X | Emergency Medicine | | 250301 | PENNSYLVANIA | No |
| 6 | 207Q00000X | Family Medicine | | | | Yes |
| 7 | 207R00000X | Internal Medicine | | | | No |
| 8 | 207RI0200X | Internal Medicine | Infectious Disease | | | No |
| 9 | 207V00000X | Obstetrics & Gynecology | | | | No |
| 10 | 207ZP0105X | Pathology | Clinical Pathology/Laboratory Medicine | 25301 | PENNSYLVANIA | No |
| 11 | 208000000X | Pediatrics | | | | No |
| 12 | 2081P2900X | Physical Medicine & Rehabilitation | Pain Medicine | 250301 | PENNSYLVANIA | No |
| 13 | 2083P0901X | Preventive Medicine | Public Health & General Preventive Medicine | | | No |
| 14 | 2084P0800X | Psychiatry & Neurology | Psychiatry | 250301 | PENNSYLVANIA | No |
| 15 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | 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 | 0942174000 | OTHER | PENNSYLVANIA | KEYSTONE |
| 2 | 1377723 | OTHER | PENNSYLVANIA | HIGHMARK |
| 3 | CI1598 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 4 | 449181 | OTHER | PENNSYLVANIA | KEYSTONE |
| 5 | 03192200 | OTHER | PENNSYLVANIA | BLUE CROSS |
| 6 | 1377738 | OTHER | PENNSYLVANIA | HIGH MARK |
| 7 | 1377740 | OTHER | PENNSYLVANIA | HIGHMARK |
| 8 | 2069277000 | MEDICAID | PENNSYLVANIA | |
| 9 | 218968 | OTHER | PENNSYLVANIA | HEALTHAMERICA |
| 10 | 50067200 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS-PC |
| 11 | 7926 | OTHER | PENNSYLVANIA | GEISINGER |
| 12 | 100196547 | MEDICAID | PENNSYLVANIA | |
| 13 | 2031714 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD-PC |
| 14 | 2900700 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS & KHP |
| 15 | 1580244 | OTHER | PENNSYLVANIA | GATEWAY-PC |
| 16 | 08263 | OTHER | PENNSYLVANIA | HEALTH PARTNERS |
| 17 | 20085767 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY-PC |
| 18 | 229284 | OTHER | PENNSYLVANIA | MAMSI, ALLIANCE, OPTIMUM |
| 19 | 261776 | OTHER | PENNSYLVANIA | UNISON-PC |
| 20 | 3192200 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS & KHP |
| 21 | 60592 | MEDICAID | PENNSYLVANIA | |
| 22 | 390046 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS & KHP |
| 23 | 676462 | OTHER | PENNSYLVANIA | AETNA |
