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 | 207V00000X | Obstetrics & Gynecology | | 76652 | MASSACHUSETTS | No |
| 2 | 207VF0040X | Obstetrics & Gynecology | Urogynecology and Reconstructive Pelvic Surgery | 76652 | MASSACHUSETTS | 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 | J13545 | OTHER | | BLUE CARE ELECT |
| 2 | 1060988 | OTHER | | FIRST HEALTH |
| 3 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 4 | 5070604 | OTHER | | AETNA US HEALTHCARE |
| 5 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 6 | 042472266 | OTHER | | THREE RIVERS |
| 7 | 3212073 | OTHER | | CIGNA HEALTH PLAN |
| 8 | AA6366 | OTHER | | HARVARD PILGRIM HLTHCARE |
| 9 | J13545 | OTHER | | BLUE SHIELD INDEMNITY |
| 10 | 406954 | OTHER | | TUFTS HEALTH PLAN |
| 11 | 28030 | OTHER | | HEALTHY START |
| 12 | 110052917A | MEDICAID | MASSACHUSETTS | |
| 13 | 784221 | OTHER | | MVP HEALTH CARE |
| 14 | 9901002 | OTHER | | FALLON COMMUNITY HEALTH |
| 15 | 042472266 | OTHER | | UNITED HEALTHCARE |
| 16 | J13545 | OTHER | | BLUE SHIELD HMO BLUE |
| 17 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 18 | 28030 | OTHER | | CHILDRENS MED SECURITY |
