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 | 207R00000X | Internal Medicine | | 80026 | MASSACHUSETTS | No |
| 2 | 207RH0002X | Internal Medicine | Hospice and Palliative Medicine | 80026 | MASSACHUSETTS | No |
| 3 | 207RG0300X | Internal Medicine | Geriatric Medicine | 80026 | 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 | 042472266 | OTHER | | HEALTHCARE VALUE MGMT |
| 2 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 3 | 1061182 | OTHER | | FIRST HEALTH |
| 4 | 110175052 | OTHER | | RAILROAD MEDICARE |
| 5 | 6633909 | OTHER | | CIGNA HEALTH PLAN |
| 6 | 7001328 | OTHER | | AETNA US HEALTHCARE |
| 7 | 784073 | OTHER | | MVP HEALTH CARE |
| 8 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 9 | 27190 | OTHER | | CHILDRENS MED SEC PLAN |
| 10 | 27190 | OTHER | | HEALTHY START |
| 11 | E87046 | MEDICARE UPIN | | |
| 12 | J14922 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 13 | 991122 | OTHER | | FALLON COMMUNITY HEALTH P |
| 14 | AA2364 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 15 | J14922 | OTHER | | BLUE CARE ELECT |
| 16 | J14922 | OTHER | | BLUE SHIELD HMO BLUE |
| 17 | 0400961 | OTHER | | EVERCARE |
| 18 | J14922 | OTHER | | MEDICARE B |
| 19 | 3131335 | MEDICAID | MASSACHUSETTS | |
| 20 | J14922 | OTHER | | BLUE SHIELD INDEMNITY |
