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 | 2085R0202X | Radiology | Diagnostic Radiology | 58675 | 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 | 27032 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 2 | 3026272 | MEDICAID | MASSACHUSETTS | |
| 3 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 7384295 | OTHER | | AETNA US HEALTHCARE |
| 5 | J06727 | OTHER | | MEDICARE B |
| 6 | 1179211 | OTHER | | CIGNA HEALTH PLAN |
| 7 | J06727 | OTHER | | BLUE SHIELD INDEMNITY |
| 8 | 300081204 | OTHER | | RAILROAD MEDICARE |
| 9 | 7996 | OTHER | | FALLON COMMUNITY HEALTH P |
| 10 | AA2843 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 11 | 1150385 | OTHER | | FIRST HEALTH |
| 12 | 784218 | OTHER | | MVP HEALTH CARE |
| 13 | J06727 | OTHER | | BLUE CARE ELECT |
| 14 | J06727 | OTHER | | BLUE SHIELD HMO BLUE |
| 15 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 16 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 17 | 27032 | OTHER | | HEALTHY START |
| 18 | 3026272 | OTHER | | MEDICAID WELFARE |
