| NPI Number |
1205897808 |
| Credentials |
MD
|
| Entity |
Individual
|
| Enumeration date |
03/31/2006 |
| Last updated |
01/22/2025 - More than a year ago
|
| Sole proprietor1 |
No
|
| Identifiers |
- MD License #: D0067927
- NJ License #: 25MA09102200
- PA License #: MD030514E
- MD Medicaid: 415607200
- NJ Medicaid: 0304034
- PA Medicaid: 001167823 0005
- PA Medicaid: 0011678230001
- Other: 57573 AETNA HEALTH PLAN
- Other: 300016308 RAILROAD MEDICARE
- DC Other: 0002 CAREFIRST BCBS
- DC Other: 0003 CAREFIRST BCBS
- DC Other: 0008 CAREFIRST BCBS
- MD Other: 4339828 AETNA
- MD Other: 3603456 AMERICHOICE - BELCAMP OFFICE
- MD Other: 3603455 AMERICHOICE- BEL AIR OFFICE
- MD Other: 01228581 AMERIGROUP
- MD Other: 01415563 AMERIGROUP (OMB)
- MD Other: 88102701 (GREENBELT) CAREFIRST BCBS
- MD Other: 88102701 GREENBELT CAREFIRST BCBS
- MD Other: 940725-01 CAREFIRST BCBS
- MD Other: 94072503 (GETTYSBURG CAREFIRST BCBS
- MD Other: 94072504 LITTLESTOWN CAREFIRST BCBS
- MD Other: 94072506 CAREFIRST BCBS
- MD Other: 6882-0006 CAREFIRST BCBS DC
- MD Other: P00928691 RAILROAD MEDICARE (OMB)
- NJ Other: 4339828 AETNA
- NJ Other: 01666607 AMERIGROUP
- NJ Other: 3884504000 AMERIHEALTH
- NJ Other: 1096774 CIGNA
- NJ Other: 2671198 GHI
- NJ Other: 60101993 HORIZON NJ HEALTH
- NJ Other: P01055829 RAILROAD MEDICARE
- PA Other: 4339828 AETNA PROVIDER #
- PA Other: 50088876 CAPITOL BLUE CROSS
- PA Other: 195426 HIGHMARK BCBS
- PA Other: HO0000195426 HIGHMARK BLUE SHIELD
- PA Other: 1191658000 KEYSTONE HEALTH PLAN EAST
- PA Other: 1030965 KEYSTONE MERCY HEALTH PLA
- PA Other: 0091658000 PERSONAL CHOICE
|
| Hospital affiliation |
n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.