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 | 174400000X | Specialist | | MD-027471-E | 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 | 0900660001 | OTHER | PENNSYLVANIA | MEDICARE DME |
| 2 | 121680 | OTHER | PENNSYLVANIA | BLUE CROSS/BLUE SHIELD |
| 3 | 2Y3801 | OTHER | PENNSYLVANIA | HEALTHNET |
| 4 | 0010980000002 | MEDICAID | PENNSYLVANIA | |
| 5 | 000000075915 | OTHER | PENNSYLVANIA | MEDPLUS |
| 6 | 505911 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 7 | 01042501 | OTHER | DISTRICT OF COLUMBIA | CAPITAL BLUE CROSS |
| 8 | 10518 6365 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 9 | 077284 | OTHER | PENNSYLVANIA | FIRST PRIORITY HEALTH |
| 10 | 20010385 | OTHER | | AMERIHEALTH MERCY |
| 11 | 340009432 | OTHER | PENNSYLVANIA | TRAVELER'S RAILROAD MEDIC |