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 | | D0038598 | 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 | 2172961 | OTHER | MARYLAND | MAMSI |
| 2 | IND 42470702 GP S186 | OTHER | MARYLAND | CAREFIRST BLUE SHIELD |
| 3 | 01996401 GP 02426700 | OTHER | MARYLAND | CAPITAL BLUE CROSS |
| 4 | 544431400 793251101 | MEDICAID | MARYLAND | |
| 5 | 573726 GRP 59855 | OTHER | MARYLAND | PA BLUE SHIELD MD LOCATIO |
| 6 | E20306 | MEDICARE UPIN | MARYLAND | |
| 7 | 643541 GRP 593934 | OTHER | MARYLAND | PA BS, PA LOCATION |
| 8 | 0001 H883 | OTHER | MARYLAND | CAREFIRST REGIONAL NETWRK |
| 9 | U055 GRP S186 | MEDICARE ID-TYPE UNSPECIFIED | MARYLAND | MEDICARE IND AND GRP |
