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 | 207R00000X | Internal Medicine | | 2006-01666 | NORTH CAROLINA | 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 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 2 | P00253383 | OTHER | | RAILROAD MEDICARE |
| 3 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 466559 | OTHER | | TUFTS HEALTH PLAN |
| 5 | 7977717 | OTHER | | AETNA US HEALTHCARE |
| 6 | 2103966 | OTHER | | MEDICAID WELFARE |
| 7 | 87425 | OTHER | | HEALTHY START |
| 8 | AA37371 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 9 | 4613180 | OTHER | | CIGNA HEALTH PLAN |
| 10 | 87425 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 11 | 92443 | OTHER | | FALLON COMMUNITY HEALTH P |
| 12 | I32472 | MEDICARE UPIN | | |
| 13 | 2103966 | MEDICAID | MASSACHUSETTS | |
| 14 | J28914 | OTHER | | BLUE SHIELD HMO BLUE |
| 15 | 0408351 | OTHER | | EVERCARE |
| 16 | J28914 | OTHER | | BLUE CARE ELECT |
| 17 | A38519 | MEDICARE ID-TYPE UNSPECIFIED | | B |
| 18 | A38519 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 19 | 042472266 | OTHER | | UNITED HEALTHCARE |
| 20 | 789683 | OTHER | | MVP HEALTH CARE |
