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 | 2083X0100X | Preventive Medicine | Occupational Medicine | 34663 | 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 | 3319417 | OTHER | | CIGNA HEALTH PLAN |
| 2 | B47145 | OTHER | | BLUE CARE ELECT |
| 3 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 4 | 042472266 | OTHER | | THREE RIVERS |
| 5 | B47145 | OTHER | | BLUE SHIELD HMO BLUE |
| 6 | B47145 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 7 | 7956315 | OTHER | | AETNA |
| 8 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYST |
| 9 | 2008874 | OTHER | | MEDICAID WELFARE |
| 10 | 659084 | OTHER | | FIRST HEALTH |
| 11 | 785966 | OTHER | | MVP HEALTH CARE |
| 12 | 042472266 | OTHER | | TRICARE |
| 13 | 7956315 | OTHER | | US HEALTHCARE |
| 14 | A36470 | MEDICARE UPIN | | |
| 15 | 2008874 | MEDICAID | MASSACHUSETTS | |
| 16 | B47145 | OTHER | | MEDICARE B |
| 17 | B47145 | OTHER | | BLUE SHIELD INDEMNITY |
| 18 | 042472266 | OTHER | | CHAMPUS |
| 19 | 54330 | OTHER | | FALLON COMM HEALTH PLAN |
| 20 | AA26155 | OTHER | | HARVARD PILGRIM HLTHCARE |
