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 | | 38517 | 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 | 2105073 | OTHER | | FIRST HEALTH |
| 2 | 45519 | OTHER | | CHILDRENS MED SECURITY PL |
| 3 | 4768 | OTHER | | FALLON COMMUNITY HLTH PL |
| 4 | 784076 | OTHER | | MVP HEALTH CARE |
| 5 | AA2365 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 6 | B22015 | OTHER | | MEDICARE B |
| 7 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 8 | 042472266008 | OTHER | | TRICARE/CHAMPUS |
| 9 | 0404598 | OTHER | | EVERCARE |
| 10 | B22015 | OTHER | | BLUE SHIELD HMO BLUE |
| 11 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 12 | 380001952 | OTHER | | RAILROAD MEDICARE |
| 13 | 042472266 | OTHER | | THREE RIVERS |
| 14 | 45519 | OTHER | | HEALTHY START |
| 15 | 0101699 | OTHER | | MEDICAID/WELFARE |
| 16 | 4582679 | OTHER | | AETNA/US HEALTHCARE |
| 17 | B22015 | OTHER | | BLUE CARE ELECT |
| 18 | B22015 | OTHER | | BLUE SHIELD INDEMNITY |
