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 | | 155472 | 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 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 2 | 33818 | OTHER | | FALLON COMMUNITY HEALTH P |
| 3 | G73245 | MEDICARE UPIN | | |
| 4 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 5 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 6 | J19300 | OTHER | | BLUE SHIELD INDEMNITY |
| 7 | 2752269 | OTHER | | CIGNA HEALTH PLAN |
| 8 | 4125321 | OTHER | | MVP HEALTH CARE |
| 9 | A28584 | OTHER | MASSACHUSETTS | MEDICARE ID |
| 10 | 419321 | OTHER | | TUFTS HEALTH PLAN |
| 11 | 0401698 | OTHER | | EVERCARE |
| 12 | 042472266 | OTHER | | HEALTHCARE VALUE MGMT |
| 13 | 3186091 | MEDICAID | MASSACHUSETTS | |
| 14 | J19300 | OTHER | | BLUE SHIELD HMO BLUE |
| 15 | 7189606 | OTHER | | AETNA US HEALTHCARE |
| 16 | 042472266 | OTHER | | THREE RIVERS |
| 17 | J19300 | OTHER | | BLUE CARE ELECT |
| 18 | 2039835 | OTHER | | FIRST HEALTH |
| 19 | AA1246 | OTHER | | HARVARD PILGRIM HEALTHCAR |
