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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 71660 | 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 | 1061138 | OTHER | | FIRST HEALTH |
| 2 | 26916 | OTHER | | CHILDRENS MED SECURITY |
| 3 | J16208 | OTHER | | BLUE SHIELD HMO BLUE |
| 4 | 5818752 | OTHER | | CIGNA HEALTH PLAN |
| 5 | A20386 | OTHER | | MEDICARE B |
| 6 | J16208 | OTHER | | BLUE SHIELD INDEMNITY |
| 7 | AA2840 | OTHER | | HARVARD PILGRIM |
| 8 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 9 | 5432660 | OTHER | | AETNA US HEALTHCARE |
| 10 | 784062 | OTHER | | MVP HEALTH CARE |
| 11 | J16208 | OTHER | | BLUE CARE ELECT |
| 12 | 2500247 | OTHER | | EVERCARE |
| 13 | G08975 | MEDICARE UPIN | | |
| 14 | A20386 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 15 | 26916 | OTHER | | HEALTHY START |
| 16 | 3137201 | OTHER | | MEDICAID PCC |
| 17 | 3142558 | OTHER | | MEDICAID WELFARE |
| 18 | 043058466 | OTHER | | HEALTHCARE VALUE MGMT |
| 19 | 991143 | OTHER | | FALLON COMMUNITY HEALTH |
| 20 | 3142558 | MEDICAID | MASSACHUSETTS | |