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 | 207RG0100X | Internal Medicine | Gastroenterology | MD4540 | DELAWARE | No |
2 | 207RG0100X | Internal Medicine | Gastroenterology | MD056201L | PENNSYLVANIA | No |
3 | 207RG0100X | Internal Medicine | Gastroenterology | MA55617 | NEW JERSEY | 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 | 0809896000 | OTHER | | AMERIHEALTH, HMO, KEYSTONE, IBC |
2 | 6574505 | MEDICAID | NEW JERSEY | |
3 | 784860 | MEDICARE PIN | | |
4 | 010003877 00 | OTHER | | AMERICHOICE |
5 | 784860 | OTHER | | AMERIHEALTH PPO |
6 | 2352993000 | OTHER | | AMERIHEALTH OF DE |
7 | G01766C03 | OTHER | | DELAWARE MEDICARE |
8 | P370138 | OTHER | | OXFORD HEALTH PLAN |
9 | 3K6074 | OTHER | | HEALTHNET |
10 | 3643291 | OTHER | | AETNA US-HEALTHCARE |
11 | 13558 | OTHER | | UNIVERSITY HEALTH PLAN |
12 | G04924 | MEDICARE UPIN | | |
13 | 1000034777 | MEDICAID | DELAWARE | |
14 | 1021674 | OTHER | | HORIZON NJ HEALTH |
15 | 110104030 | OTHER | | RAIL ROAD MEDICARE |
16 | 1756340 | OTHER | | UNITED HEALTH CARE |
17 | 0514012 | OTHER | | AETNA |
18 | 1678781 | OTHER | | AMERIHEALTH PPO OF DE |