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 | 208600000X | Surgery | | 160784 | 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 | 2023718 | OTHER | | CIGNA HEALTH PLAN |
| 2 | 3208125 | OTHER | | MEDICAID WELFARE |
| 3 | 7985198 | OTHER | | AETNA US HEALTHCARE |
| 4 | 3208125 | MEDICAID | MASSACHUSETTS | |
| 5 | 419312 | OTHER | | TUFTS HEALTH PLAN |
| 6 | 784068 | OTHER | | MVP HEALTH CARE |
| 7 | 2230931 | OTHER | | FIRST HEALTH |
| 8 | 784069 | OTHER | | MVP HEALTH CARE |
| 9 | J22264 | OTHER | | BLUE CARE ELECT |
| 10 | 04 2472266 | OTHER | | PRIVATE HEALTHCARE SYST. |
| 11 | 04 2472266 | OTHER | | ONE HEALTH PLAN |
| 12 | 04 2472266 | OTHER | | THREE RIVERS |
| 13 | 70438 | OTHER | | CHILDRENS MEDICAL |
| 14 | 70438 | OTHER | | HEALTHY START |
| 15 | J22264 | OTHER | | BLUE SHIELD HMO BLUE |
| 16 | AA16160 | OTHER | | HARVARD PILGRIM HEALTH |
| 17 | 60679 | OTHER | | FALLON COMMUNITY HEALTH |
| 18 | A37468 | OTHER | | MEDICARE B |
