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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 31210 | 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 | 2501884 | OTHER | | EVERCARE |
| 2 | 784021 | OTHER | | MVP HEALTH CARE |
| 3 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 4 | J26791 | OTHER | | BLUE SHIELD HMO BLUE |
| 5 | J26791 | OTHER | | BLUE SHIELD INDEMNITY |
| 6 | 042472266 | OTHER | | THREE RIVERS |
| 7 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 8 | 2127489 | OTHER | | FIRST HEALTH |
| 9 | 4270345 | OTHER | | AETNA US HEALTHCARE |
| 10 | 441346 | OTHER | | TUFTS HEALTH PLAN |
| 11 | 47644 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 12 | 67507 | OTHER | | FALLON COMMUNITY HEALTH |
| 13 | 3842103 | OTHER | | CIGNA HEALTH PLAN |
| 14 | A35143 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 15 | 042472266 | OTHER | | UNITED HEALTHCARE |
| 16 | 2003121 | MEDICAID | MASSACHUSETTS | |
| 17 | 47644 | OTHER | | HEALTHY START |
| 18 | AA5962 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 19 | J26791 | OTHER | | BLUE CARE ELECT |
| 20 | B77907 | MEDICARE UPIN | | |
