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 | 208200000X | Plastic Surgery | | MD21059 | DISTRICT OF COLUMBIA | 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 | 2573303 | OTHER | MARYLAND | AETNA |
| 2 | 027436600 | MEDICAID | DISTRICT OF COLUMBIA | |
| 3 | G06603 | MEDICARE UPIN | DISTRICT OF COLUMBIA | |
| 4 | 10239484 | OTHER | MARYLAND | AMERIGROUP |
| 5 | 3127603 | OTHER | MARYLAND | MAMSI/OPTIMUM CHOICE |
| 6 | 1300634 | OTHER | MARYLAND | UNITED HEALTH CARE/MEDICAID |
| 7 | 2206407 | OTHER | MARYLAND | UNITED HEALTH CARE |
| 8 | 118302801 | MEDICAID | MARYLAND | |
| 9 | 64131802 | OTHER | MARYLAND | CAREFIRST BLUE CHOICE |
| 10 | 06370001 | OTHER | DISTRICT OF COLUMBIA | CAREFIRST BLUE CROSS BLUE SHIELD |
| 11 | 12206 | OTHER | DISTRICT OF COLUMBIA | DC CHARTERED HEALTH |
| 12 | P00006594 | OTHER | MARYLAND | MEDICARE RAILROAD |
| 13 | 778548 | MEDICARE PIN | DISTRICT OF COLUMBIA | |
