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 | 2085R0202X | Radiology | Diagnostic Radiology | 11321 | WEST VIRGINIA | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | 35-04-6413-K | OHIO | No |
| 3 | 2085R0202X | Radiology | Diagnostic Radiology | 48525 | MASSACHUSETTS | No |
| 4 | 2085R0202X | Radiology | Diagnostic Radiology | 26063 | NORTH CAROLINA | No |
| 5 | 2085R0202X | Radiology | Diagnostic Radiology | MD-031175-E | PENNSYLVANIA | No |
| 6 | 2085R0202X | Radiology | Diagnostic Radiology | 19304 | NEBRASKA | No |
| 7 | 2085R0202X | Radiology | Diagnostic Radiology | 01042077A | INDIANA | No |
| 8 | 2085R0202X | Radiology | Diagnostic Radiology | 4301062874 | MICHIGAN | No |
| 9 | 2085R0202X | Radiology | Diagnostic Radiology | 0101050752 | VIRGINIA | No |
| 10 | 2085R0202X | Radiology | Diagnostic Radiology | D0046723 | MARYLAND | No |
| 11 | 2085R0202X | Radiology | Diagnostic Radiology | ME24368 | FLORIDA | 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 | 01042077A | OTHER | INDIANA | INDIANA LICENSE |
| 2 | 0101050752 | OTHER | VIRGINIA | VIRGINIA LICENSE |
| 3 | ME24368 | OTHER | FLORIDA | FLORIDA LICENSE |
| 4 | D0046723 | OTHER | MARYLAND | MARYLAND LICENSE |
| 5 | 11321 | OTHER | WEST VIRGINIA | WEST VIRGINIA LICENSE |
| 6 | 19304 | OTHER | NEBRASKA | NEBRASKA LICENSE |
| 7 | 48949 | OTHER | | BCBS |
| 8 | 48949Z | MEDICARE PIN | FLORIDA | |
| 9 | 26063 | OTHER | NORTH CAROLINA | NORTH CAROLINA LICENSE |
| 10 | 35-04-6413-K | OTHER | OHIO | OHIO LICENSE |
| 11 | 4301062874 | OTHER | MICHIGAN | MICHIGAN LICENSE |
| 12 | 270831100 | MEDICAID | FLORIDA | |
| 13 | A72630 | MEDICARE UPIN | | |
| 14 | P00145536 | MEDICARE PIN | | |
| 15 | MD-031175-E | OTHER | PENNSYLVANIA | PENNSYLVANIA LICENSE |
| 16 | 48525 | OTHER | MASSACHUSETTS | MASSACHUSETTS LICENSE |
