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 | | D0064678 | MARYLAND | No |
| 2 | 207X00000X | Orthopaedic Surgery | | 0101239951 | VIRGINIA | No |
| 3 | 207X00000X | Orthopaedic Surgery | | MD036127 | DISTRICT OF COLUMBIA | No |
| 4 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | 0101239951 | VIRGINIA | No |
| 5 | 207XS0106X | Orthopaedic Surgery | Hand Surgery | D0064678 | 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 | P00457403 | OTHER | MARYLAND | RAIL ROAD MEICARE |
| 2 | 238575 | OTHER | | ANTHEM PROVIDER # |
| 3 | 238578 | OTHER | | ANTHEM PROVIDER # |
| 4 | 0254450001 | MEDICARE NSC | | |
| 5 | 462LQ643 | OTHER | MARYLAND | MARYLAND MEDICARE |
| 6 | I60636 | MEDICARE UPIN | | |
| 7 | 019805G08 | MEDICARE ID-TYPE UNSPECIFIED | DISTRICT OF COLUMBIA | METRO MEDICARE PROVIDER# |
| 8 | 892834 | OTHER | MARYLAND | BCBS MD INDIV PROV# |
| 9 | 0458905 | OTHER | | CIGNA PROVIDER # |
| 10 | P00457403 | OTHER | VIRGINIA | RAIL ROAD MEDICARE |
| 11 | 0254450002 | MEDICARE NSC | | |
| 12 | 176608 | OTHER | DISTRICT OF COLUMBIA | METRO MEDICARE GMO GRP# |
| 13 | 763904 | OTHER | | NCPPO PROVIDER# |
| 14 | 7799886 | OTHER | | AETNA PPO PROVIDER# |
| 15 | 238582 | OTHER | | ANTHEM PROVIDER # |
| 16 | 1359236 | OTHER | | AETNA HMO |
| 17 | 52 1054342 | OTHER | | GMO GROUP TAX ID # |
| 18 | 46950028 | OTHER | DISTRICT OF COLUMBIA | BCBS NCA PROVIDER# |
| 19 | 5722200 | OTHER | | FIRST HEALTH PROVIDER# |