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 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | 1486 | 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 | 26816 | OTHER | | HEALTHY START |
| 2 | 480026225 | OTHER | | RAILROAD MEDICARE |
| 3 | 785962 | OTHER | | MVP HEALTH CARE |
| 4 | 9900803 | OTHER | | FALLON COMMUNITY HEALTH |
| 5 | Y70603 | OTHER | | BLUE SHIELD INDEMNITY |
| 6 | 042472266 | OTHER | | THREE RIVERS |
| 7 | 7157347 | OTHER | | AETNA |
| 8 | 7157347 | OTHER | | US HEALTHCARE |
| 9 | AA2361 | OTHER | | HARVARD PILGRIM |
| 10 | Y70603 | OTHER | | BLUE SHIELD HMO BLUE |
| 11 | Y70603 | OTHER | | MEDICARE B |
| 12 | Y70603 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 13 | 8296705 | OTHER | | CIGNA PAL ID |
| 14 | 918064 | OTHER | | FIRST HEALTH |
| 15 | Y70603 | OTHER | | BLUE CARE ELECT |
| 16 | T58682 | MEDICARE UPIN | | |
| 17 | 042472266 | OTHER | | HEALTHCARE VALUE MGMT |
| 18 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 19 | 042472266 | OTHER | | PRIVATE HEALTHCARE |
| 20 | 26816 | OTHER | | CMSP |
