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 | 208200000X | Plastic Surgery | | 036806 | CONNECTICUT | No |
| 2 | 2086S0122X | Surgery | Plastic and Reconstructive Surgery | 036806 | CONNECTICUT | 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 | 0368061384 | OTHER | CONNECTICUT | CONNECTICARE |
| 2 | 06-1406459 | OTHER | CONNECTICUT | CORVEL |
| 3 | 240000132 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 4 | 010036806CT01 | OTHER | CONNECTICUT | ANTHEM BCBS |
| 5 | 4273999 001 | OTHER | CONNECTICUT | CIGNA |
| 6 | 06-1406459 | OTHER | CONNECTICUT | FOCUS |
| 7 | 06-1406459 | OTHER | CONNECTICUT | NORTHEAST HEALTH DIRECT |
| 8 | 0S0381 | OTHER | CONNECTICUT | HEALTH NET |
| 9 | 2055859 | OTHER | CONNECTICUT | AETNA |
| 10 | 06-1406459 | OTHER | CONNECTICUT | HMC, PPO |
| 11 | 06-1406459 | OTHER | CONNECTICUT | MULTIPLAN |
| 12 | 3183033 | MEDICAID | MASSACHUSETTS | |
| 13 | 001368069 | MEDICAID | CONNECTICUT | |
| 14 | P1131448 | OTHER | CONNECTICUT | OXFORD |
| 15 | 06-1406459 | OTHER | CONNECTICUT | COLONIAL COOPERATIVE CARE |
| 16 | 06-1406459 | OTHER | CONNECTICUT | UNITED HEALTHCARE |
| 17 | G70453 | MEDICARE UPIN | | |
| 18 | 23415 | OTHER | CONNECTICUT | HEALTH NEW ENGLAND |
| 19 | 06-1406459 | OTHER | CONNECTICUT | GREAT WEST HEALTHCARE |
| 20 | 06-1406459 | OTHER | CONNECTICUT | PRIVATE HEALTHCARE SYSTEM |
