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 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | 35-054099 | OHIO | 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 | PAR | OTHER | VIRGINIA | VIRGINIA HEALTH NETWORK (EVMS HEALTH SERVICES) |
| 2 | 9631110 | OTHER | VIRGINIA | AETNA (EVMS HEALTH SERVICES) |
| 3 | 110186173 | MEDICARE PIN | VIRGINIA | |
| 4 | -033 | OTHER | VIRGINIA | TRICARE/CHAMPUS (EVMS HEALTH SERVICES) |
| 5 | 362893 | OTHER | VIRGINIA | ANTHEM BC/BS (EVMS HEALTH SERVICES 600 GRESHAM DR.) |
| 6 | PAR | OTHER | VIRGINIA | VA PREMIER HEALTH (EVMS HEALTH SERVICES) |
| 7 | 10040054 | OTHER | VIRGINIA | SENTARA/OPTIMA HEALTH (EVMS HEALTH SERVICES) |
| 8 | 0583J | OTHER | NORTH CAROLINA | BC/BS |
| 9 | PAR | OTHER | VIRGINIA | CORVEL/CORCARE (EVMS HEALTH SERVICES) |
| 10 | 890583J | MEDICAID | NORTH CAROLINA | |
| 11 | MC12350 | MEDICARE PIN | VIRGINIA | |
| 12 | 3196138 | OTHER | VIRGINIA | UNITED HEALTH CARE/MAMSI (EVMS HEALTH SERVICES) |
| 13 | PAR | OTHER | VIRGINIA | USA MANAGED CARE (EVMS HEALTH SERVICES) |
| 14 | PAR | OTHER | VIRGINIA | MULTIPLAN (EVMS HEALTH SERVICES) |
| 15 | 2997964 | OTHER | VIRGINIA | CIGNA (EVMS HEALTH SERVICES) |
| 16 | 362903 | OTHER | VIRGINIA | ANTHEM BC/BS (EVMS HEALTH SERVICES DIABETES INSTITUTE) |
| 17 | PAR | OTHER | VIRGINIA | FIRST HEALTH COMMERCIAL (EVMS HEALTH SERVICES) |
| 18 | 1043361835 | MEDICAID | VIRGINIA | |
