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 | 207Q00000X | Family Medicine | | 58233 | 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 | 1150309 | OTHER | | FIRST HEALTH |
| 2 | 5884434 | OTHER | | AETNA US HEALTHCARE |
| 3 | E35311 | MEDICARE UPIN | | |
| 4 | 3103820 | MEDICAID | MASSACHUSETTS | |
| 5 | J08904 | OTHER | | BLUE SHIELD INDEMNITY |
| 6 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 7 | 26998 | OTHER | | HEALTHY START |
| 8 | 3103820 | OTHER | | MEDICAID WELFARE |
| 9 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGMEN |
| 10 | 784185 | OTHER | | MVP HEALTH CARE |
| 11 | AA1224 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 12 | 0100294 | OTHER | | EVERCARE |
| 13 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 14 | 26998 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 15 | J08904 | OTHER | | BLUE CARE ELECT |
| 16 | J08904 | OTHER | | BLUE SHIELD HMO BLUE |
| 17 | 9900287 | OTHER | | FALLON COMMUNITY HEALTH P |
| 18 | J08904 | OTHER | | MEDICARE B |
| 19 | 3521498 | OTHER | | CIGNA HEALTH PLAN |
| 20 | J08904 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |