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 | 207Q00000X | Family Medicine | | 042.0015365 | VERMONT | 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 | 010122729 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE ID# |
| 2 | 0106222YPNH01 | OTHER | NEW HAMPSHIRE | ANTHEM ID# |
| 3 | G33728 | OTHER | NEW HAMPSHIRE | HARVARD PILGRIM ID # |
| 4 | 222594672 | OTHER | NEW HAMPSHIRE | GREATWEST HEALTHCARE ID# |
| 5 | 2139311 | OTHER | NEW HAMPSHIRE | CIGNA ID # |
| 6 | 222594672 | OTHER | NEW HAMPSHIRE | PRIVATE HEALTH CARE ID# |
| 7 | 3009542 | MEDICAID | NEW HAMPSHIRE | |
| 8 | 371551 | OTHER | NEW HAMPSHIRE | MVP HEALTHCARE ID# |
| 9 | 0106222Y0NH01 | OTHER | NEW HAMPSHIRE | ANTHEM HFH ID# |
| 10 | 222594672 | OTHER | NEW HAMPSHIRE | HEALTH CARE VALUE MANAG# |
| 11 | 3016256 | OTHER | NEW HAMPSHIRE | AETNA ID# |
| 12 | H005016 | OTHER | NEW HAMPSHIRE | TRICARE ID# |
| 13 | 01-04592 | OTHER | NEW HAMPSHIRE | UNITED HEALTHCARE ID# |
| 14 | 371552 | OTHER | NEW HAMPSHIRE | MVP HEALTHCARE HFH ID# |
