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 | 208200000X | Plastic Surgery | | 39109 | NORTH CAROLINA | 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 | 4277020 | OTHER | | AETNA HMO PPO POS |
| 2 | 80272 | OTHER | NORTH CAROLINA | NC BLUE CROSS BLUE SHIEL |
| 3 | 39109 | OTHER | NORTH CAROLINA | NC MEDICAL BOARD |
| 4 | 709032 | OTHER | | FIRST HEALTH |
| 5 | 0292 | OTHER | | ONE HEALTH PLAN |
| 6 | P00102629 | OTHER | | MEDICARE UHC RAILROAD |
| 7 | 2155496 | MEDICARE PIN | NORTH CAROLINA | |
| 8 | 13 41698 | OTHER | | UNITED HEALTHCARE |
| 9 | 8980272 | MEDICAID | NORTH CAROLINA | |
| 10 | 80272 | OTHER | | BCBS STATE HEALTH PLAN |
| 11 | N39109 | MEDICAID | SOUTH CAROLINA | |
| 12 | 15069 | OTHER | | MEDICARE ADVANTAGE HMO |
| 13 | 15069 | OTHER | | PARTNERS MEDICARE CHOICE |
| 14 | 86033 | OTHER | | CIGNA MEDICARE ACCESS |
| 15 | 6457570 | OTHER | | CIGNA |
| 16 | E 61236 | MEDICARE UPIN | | |
