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 | 213E00000X | Podiatrist | | DPM00240 | RHODE ISLAND | 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 | R003457 | OTHER | RHODE ISLAND | WPS TRICARE |
| 2 | 007011766 | MEDICARE PIN | RHODE ISLAND | |
| 3 | 782937 | OTHER | RHODE ISLAND | AETNA |
| 4 | 0000000007071 | OTHER | RHODE ISLAND | BLUE CROSS FEP |
| 5 | 0005779230 | OTHER | RHODE ISLAND | AETNA |
| 6 | 050456966 | OTHER | RHODE ISLAND | UNITED HEALTHCARE |
| 7 | 1006490001 | OTHER | RHODE ISLAND | NHIC, CORP. DME MAC |
| 8 | 2700150 | OTHER | RHODE ISLAND | UNITED HEALTHCARE OF NEW |
| 9 | 7001766 | MEDICAID | RHODE ISLAND | |
| 10 | 0000007071 | OTHER | RHODE ISLAND | BLUECHIP GROUP |
| 11 | 001868 | OTHER | RHODE ISLAND | TUFTS |
| 12 | 2343 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH |
| 13 | ZE5188 | OTHER | RHODE ISLAND | BLUE CROSS OF MA |
| 14 | 050456966 | OTHER | RHODE ISLAND | CIGNA |
| 15 | 400515 | OTHER | RHODE ISLAND | BLUECHIP OF RI |
| 16 | T70925 | MEDICARE UPIN | RHODE ISLAND | |
| 17 | 0000007071 | OTHER | RHODE ISLAND | BLUE CROSS OF RI |
| 18 | 0137515002 | OTHER | RHODE ISLAND | CIGNA |
| 19 | 050456966 | OTHER | RHODE ISLAND | WPS TRICARE |
