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 | 207RG0300X | Internal Medicine | Geriatric Medicine | 209272 | 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 | 784034 | OTHER | | MVP HEALTH CARE |
| 2 | A32547 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 3 | J23372 | OTHER | | BLUE SHIELD HMO BLUE |
| 4 | 042472266 | OTHER | | HEALTHCARE VALUE MGMT |
| 5 | 042472266 | OTHER | | THREE RIVERS |
| 6 | 49277 | OTHER | | FALLON COMMUNITY HEALTH |
| 7 | 0140481 | OTHER | | MEDICAID WELFARE |
| 8 | 5603502 | OTHER | | AETNA US HEALTHCARE |
| 9 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 10 | 380001633 | OTHER | | RAILROAD MEDICARE |
| 11 | 0140481 | MEDICAID | MASSACHUSETTS | |
| 12 | J23373 | OTHER | | BLUE SHIELD INDEMNITY |
| 13 | AA5966 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 14 | 0140481 | OTHER | | HEALTHY START |
| 15 | J23373 | OTHER | | BLUE CARE ELECT |
| 16 | 1574863 | OTHER | | CIGNA HEALTH PLAN |
| 17 | 0402313 | OTHER | | EVERCARE |
| 18 | 1601039 | OTHER | | FIRST HEALTH |
| 19 | A32547 | OTHER | | MEDICARE B |
| 20 | G38033 | MEDICARE UPIN | | |
