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 | 208000000X | Pediatrics | | 50186 | 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 | 28364 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 2 | H05070 | OTHER | | BLUE SHIELD HMO BLUE |
| 3 | H05070 | OTHER | | MEDICARE B |
| 4 | 784189 | OTHER | | MVP HEALTH CARE |
| 5 | 1293416 | OTHER | | FALLON COMMUNITY HEALTH P |
| 6 | 28364 | OTHER | | HEALTHY START |
| 7 | H05070 | OTHER | | BLUE SHIELD INDEMNITY |
| 8 | 4570514 | OTHER | | AETNA US HEALTHCARE |
| 9 | D88288 | MEDICARE UPIN | | |
| 10 | H05070 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 11 | 6658558 | OTHER | | CIGNA HEALTH PLAN |
| 12 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 13 | 2047118 | OTHER | | FIRST HEALTH |
| 14 | H05070 | OTHER | | BLUE CARE ELECT |
| 15 | 0181919 | OTHER | | MEDICAID WELFARE |
| 16 | AA1270 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 17 | 0181919 | MEDICAID | MASSACHUSETTS | |
