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 | 213EP1101X | Podiatrist | Primary Podiatric Medicine | DPM 206 | RHODE ISLAND | No |
| 2 | 213ES0131X | Podiatrist | Foot Surgery | DPM 206 | 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 | 0475951001 | OTHER | RHODE ISLAND | CIGNA |
| 2 | 9007036 | MEDICAID | RHODE ISLAND | |
| 3 | T53254 | MEDICARE UPIN | RHODE ISLAND | |
| 4 | 000432 | OTHER | RHODE ISLAND | BLUE CHIP |
| 5 | 0536455 | OTHER | RHODE ISLAND | AETNA |
| 6 | P12001350 | OTHER | RHODE ISLAND | MULTIPLAN |
| 7 | 480001530 | OTHER | RHODE ISLAND | RAILROAD MEDICARE |
| 8 | 489007036 | MEDICARE PIN | RHODE ISLAND | |
| 9 | 70366 | OTHER | RHODE ISLAND | BLUE CROSS BLUE SHIELD |
| 10 | 2700124 | OTHER | RHODE ISLAND | UNITED HEALTH CARE |
| 11 | 770036 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD |
