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 | 2083X0100X | Preventive Medicine | Occupational Medicine | 80808 | 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 | A23313 | OTHER | | MEDICARE B |
| 2 | 3175499 | MEDICAID | MASSACHUSETTS | |
| 3 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 4 | J18587 | OTHER | | BLUE SHIELD HMO BLUE |
| 5 | A53002 | MEDICARE UPIN | | |
| 6 | 0404414 | OTHER | | EVERCARE |
| 7 | AA3718 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 8 | 7240364 | OTHER | | AETNA US HEALTHCARE |
| 9 | 7415967 | OTHER | | CIGNA HEALTH PLAN |
| 10 | 7994 | OTHER | | FALLON COMMUNITY HEALTH P |
| 11 | 784094 | OTHER | | MVP HEALTH CARE |
| 12 | J18587 | OTHER | | BLUE SHIELD INDEMNITY |
| 13 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 14 | 1150379 | OTHER | | FIRST HEALTH |
| 15 | 840000270 | OTHER | | RAILROAD MEDICARE |
| 16 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 17 | 042472266 | OTHER | | THREE RIVERS |
| 18 | 3175499 | OTHER | | MEDICAID WELFARE |
| 19 | J18587 | OTHER | | BLUE CARE ELECT |
| 20 | A23313 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
