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 | | 79617 | MASSACHUSETTS | No |
| 2 | 207RI0200X | Internal Medicine | Infectious Disease | 79617 | 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 | | PRIVATE HEALTHCARE SYSTEM |
| 2 | AA2844 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 3 | J14908 | OTHER | | BLUE SHIELD HMO BLUE |
| 4 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 5 | 26881 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 6 | 5218590 | OTHER | | CIGNA HEALTH PLAN |
| 7 | 784106 | OTHER | | MVP HEALTH CARE |
| 8 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 9 | J14908 | OTHER | | BLUE SHIELD IDEMNITY |
| 10 | J14908 | OTHER | | BLUE CARE ELECT |
| 11 | 1061518 | OTHER | | FIRST HEALTH |
| 12 | 9200061 | OTHER | | EVERCARE |
| 13 | 110147355 | MEDICARE ID-TYPE UNSPECIFIED | | RAILROAD MEDICARE |
| 14 | 26881 | OTHER | | HEALTHY START |
| 15 | 91119 | OTHER | | FALLON COMMUNITY HEALTH P |
| 16 | J14908 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 17 | 3130711 | MEDICAID | MASSACHUSETTS | |
| 18 | 5237703 | OTHER | | AETNA US HEALTHCARE |
| 19 | E29912 | MEDICARE UPIN | | |
| 20 | J14908 | MEDICARE ID-TYPE UNSPECIFIED | | MEDICARE B |