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 | 261QE0700X | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment | 2052 | 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 | 0373 | OTHER | NEW YORK | MVP |
| 2 | 905627 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN INPT |
| 3 | 6300460 | OTHER | | AETNA |
| 4 | 1001728 | MEDICAID | MASSACHUSETTS | |
| 5 | 10005803 | OTHER | NEW YORK | CDPHP |
| 6 | 12257 | OTHER | MASSACHUSETTS | HEALTH NEW ENGLAND |
| 7 | 2222003830 | OTHER | MASSACHUSETTS | BLUE CROSS SDC |
| 8 | 900038 | OTHER | MASSACHUSETTS | HARVARD PILGRIM |
| 9 | 20850 | OTHER | MASSACHUSETTS | BMC HEALTH NET PLAN |
| 10 | 900245 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN OUTPT |
| 11 | 1200542 | MEDICAID | MASSACHUSETTS | |
| 12 | HO4359 | OTHER | CONNECTICUT | OXFORD HEALTH PLANS |
| 13 | 222321 | MEDICARE PIN | MASSACHUSETTS | |
| 14 | 220038 | OTHER | MASSACHUSETTS | UNICARE MA EMPLOYEE GIC |
| 15 | 2222003801 | OTHER | MASSACHUSETTS | BLUE CROSS INPATIENT |
| 16 | 2222003810 | OTHER | MASSACHUSETTS | BLUE CROSS OUTPATIENT |
| 17 | 992756 | OTHER | CONNECTICUT | CONNECTICARE |
| 18 | 221302 | OTHER | KENTUCKY | HUMANA |
