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 | 207Y00000X | Otolaryngology | | D0051704 | 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 | 02186101 GP 02426700 | OTHER | MARYLAND | CAPITAL BLUE CROSS |
| 2 | 212979 GP 218761 | OTHER | MARYLAND | MAMSI |
| 3 | 54567102 GP S186 | OTHER | MARYLAND | CAREFIRST BS INDV & GP |
| 4 | G45939 | MEDICARE UPIN | MARYLAND | |
| 5 | 0002 H883 | OTHER | MARYLAND | CAREFIRST REGIONAL NTWRK |
| 6 | 895471 GRP 593934 | OTHER | PENNSYLVANIA | PA BS PA LOCATION |
| 7 | 694T GRP S186 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | MEDICARE |
| 8 | 954364 GRP 59855 | OTHER | MARYLAND | PA BS MD LOCATION |
| 9 | 699902600 793251101 | MEDICAID | MARYLAND | |
