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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 101052820 | VIRGINIA | 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 | 060001022 | OTHER | VIRGINIA | PALMETTO MEDICARE OF VIRGINIA INDIVDUAL PTAN |
2 | 7638574 | OTHER | VIRGINIA | CIGNA HMO PROVIDER NUMBER |
3 | G00773 | OTHER | DISTRICT OF COLUMBIA | NOVITAS MEDICARE GROUP PTAN |
4 | H93564 | MEDICARE UPIN | VIRGINIA | |
5 | 10389795 | OTHER | VIRGIN ISLANDS | CAQH NUMBER |
6 | 204262266 | OTHER | VIRGINIA | TAX ID WARRENTON HEART |
7 | 2500136 | OTHER | VIRGINIA | UNITED HEALTHCARE |
8 | 2501051 | OTHER | VIRGINIA | UNITED HEALTHCARE |
9 | 154789 | OTHER | VIRGINIA | SOUTHERN HEALTH NUMBER |
10 | 562289471 | OTHER | VIRGINIA | TAX ID FOR MANASSAS HEART |
11 | C06380 | OTHER | VIRGINIA | PALMETTO MEDICARE GROUP PTAN |
12 | 00A988V73 | OTHER | DISTRICT OF COLUMBIA | NOVITAS MEDICARE INDIVIDUAL PTAN |
13 | 2337135 | OTHER | VIRGINIA | AETNA HMO PROVIDER NUMBER |
14 | 317184 | OTHER | VIRGINIA | ANTHEM PROVIDER NUMBER |
15 | 70670001 | OTHER | VIRGINIA | CAREFIRST PROVIDER NUMBER |
16 | 481440 | OTHER | VIRGINIA | OPT/MAMSI/MDIPA NUMBER |
17 | 505405 | OTHER | VIRGINIA | NCPPO PROVIDER NUMBER |
18 | 541984220 | OTHER | VIRGINIA | TAX ID FOR VIRGINIA CARDI |
19 | 7135122 | OTHER | VIRGINIA | AETNA PPO PROVIDER NUMBER |
20 | C08583 | OTHER | VIRGINIA | MEDICARE ID GROUP MANASSAS HEART |
21 | C09878 | OTHER | VIRGINIA | MEDICARE ID GROUP WARRENTON HEART |
22 | 7602707 | MEDICAID | VIRGINIA | |