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 | 2082S0099X | Plastic Surgery | Plastic Surgery Within the Head and Neck | RI5305 | RHODE ISLAND | No |
| 2 | 2082S0105X | Plastic Surgery | Surgery of the Hand | RI5305 | RHODE ISLAND | No |
| 3 | 2086S0105X | Surgery | Surgery of the Hand | RI5305 | RHODE ISLAND | No |
| 4 | 2086S0122X | Surgery | Plastic and Reconstructive Surgery | RI5305 | RHODE ISLAND | 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 | 9000759 | MEDICAID | RHODE ISLAND | |
| 2 | 4000248 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH |
| 3 | 300042 | OTHER | RHODE ISLAND | BLUE CHIP |
| 4 | 30202009 | OTHER | MASSACHUSETTS | MASS BCBS |
| 5 | C90359 | MEDICARE UPIN | | |
