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 | 207X00000X | Orthopaedic Surgery | | MD045029L | 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 | 01134401 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 2 | 3117048 | OTHER | PENNSYLVANIA | UNITED HEALTH CARE (MAMSI) |
| 3 | 875695 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 4 | MD045029L | OTHER | PENNSYLVANIA | LICENSE |
| 5 | 0015902240002 | MEDICAID | PENNSYLVANIA | |
| 6 | 25-1716306 | OTHER | PENNSYLVANIA | HEALTHNET/TRICARE |
| 7 | G920-0144/KDM4CU | OTHER | PENNSYLVANIA | CAREFIRST |
| 8 | 001590224 0006 | MEDICAID | PENNSYLVANIA | |
| 9 | 123405 | OTHER | PENNSYLVANIA | MEDPLUS |
| 10 | 847264 | OTHER | PENNSYLVANIA | AETNA HMO |
| 11 | 867633 | OTHER | PENNSYLVANIA | MEDICARE GROUP # |
| 12 | 1007307260034 | OTHER | PENNSYLVANIA | MEDICAID GROUP # |
| 13 | 11344001 | OTHER | PENNSYLVANIA | CAPITAL BLUECROSS |
| 14 | 120420411 | OTHER | PENNSYLVANIA | DEPT OF LABOR |
| 15 | 1593333 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 16 | 5532437 | OTHER | PENNSYLVANIA | AETNA NON-HMO |
| 17 | 25-1716306 | OTHER | PENNSYLVANIA | INTERGROUP |
| 18 | 25-1716306 | OTHER | PENNSYLVANIA | DEVON |
| 19 | 3117048 | OTHER | PENNSYLVANIA | MAMSI |
| 20 | P00841779 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 21 | 2117048 | OTHER | PENNSYLVANIA | ALLIANCE PPO |
| 22 | P00169019 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
