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 | 204F00000X | Transplant Surgery | | | | No |
| 2 | 207Y00000X | Otolaryngology | | | | No |
| 3 | 208200000X | Plastic Surgery | | | | No |
| 4 | 2086S0127X | Surgery | Trauma Surgery | | | No |
| 5 | 2086S0129X | Surgery | Vascular Surgery | | | No |
| 6 | 2086X0206X | Surgery | Surgical Oncology | | | No |
| 7 | 208800000X | Urology | | | | No |
| 8 | 208C00000X | Colon & Rectal Surgery | | | | No |
| 9 | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | | | | No |
| 10 | 235Z00000X | Speech-Language Pathologist | | | | No |
| 11 | 208600000X | Surgery | | | | 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 | M20844 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE THORACIC GRP # |
| 2 | M20843 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE PLASTIC GRP # |
| 3 | M20827 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE ENT GRP # |
| 4 | M20828 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MEDICARE GROUP # |
| 5 | M20830 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE GENERAL SURG GRP # |
| 6 | M20848 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE SURGONC GRP # |
| 7 | M17352 | OTHER | MASSACHUSETTS | BCBS GRP # |
| 8 | M20846 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE COLORECTAL GROUP # |
| 9 | NG0010 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE NP GRP # |
| 10 | 9700251 | MEDICAID | MASSACHUSETTS | |
| 11 | M20847 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE UROLOGY GRP # |
| 12 | M21772 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE MESO GRP # |
| 13 | M20845 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | MCARE VASCULAR GRP# |