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 | 207RG0100X | Internal Medicine | Gastroenterology | MD051169L | 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 | 110122635 | MEDICARE PIN | PENNSYLVANIA | |
| 2 | 087327800 | OTHER | PENNSYLVANIA | INDEPENDENCE BLUE SHIELD |
| 3 | 75462 | OTHER | PENNSYLVANIA | THREE RIVERS |
| 4 | 16910 5144 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 5 | 569006 | OTHER | PENNSYLVANIA | AETNA |
| 6 | 840505 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD |
| 7 | 800857 | OTHER | PENNSYLVANIA | FIRST PRIORITY HEALTH |
| 8 | G22417 | MEDICARE UPIN | PENNSYLVANIA | |
| 9 | 335775 | OTHER | PENNSYLVANIA | HEALTH ASSURANCE |
| 10 | 840505 | MEDICARE PIN | PENNSYLVANIA | |
| 11 | 1145631 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY |
| 12 | 01572861 | MEDICAID | PENNSYLVANIA | |
| 13 | 569006 | OTHER | PENNSYLVANIA | AETNA US HEALTHCARE |
| 14 | 840505 | OTHER | PENNSYLVANIA | FIRST PRIORITY LIFE INSURANCE |