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 | 207Q00000X | Family Medicine | | | | No |
| 2 | 207R00000X | Internal Medicine | | | | 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 | 1609821651 | OTHER | MASSACHUSETTS | NATIONAL PROVIDER IDENTIFIER |
| 2 | 792971 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN |
| 3 | 1245229384 | OTHER | RHODE ISLAND | BLUE CHIP RI (HMO) |
| 4 | 2117177 | MEDICAID | MASSACHUSETTS | |
| 5 | 110094147A | MEDICAID | MASSACHUSETTS | |
| 6 | 000000049693 | OTHER | MASSACHUSETTS | BMC HEALTHNET |
| 7 | M18892 | OTHER | MASSACHUSETTS | BLUE CROSS BLU SHIELD OF MASS |
| 8 | 9842957 | OTHER | MASSACHUSETTS | CIGNA |
| 9 | AA77017 | OTHER | MASSACHUSETTS | PILGRIM HEALTH CARE |
| 10 | P00373184 | OTHER | MASSACHUSETTS | RAILROAD MEDICARE |
| 11 | 0322024 | MEDICAID | MASSACHUSETTS | |
| 12 | 9735721 | MEDICAID | MASSACHUSETTS | |
| 13 | 0037831 | OTHER | MASSACHUSETTS | NEIGHBORHOOD HELATH PLAN |
| 14 | 1316922149 | OTHER | | NATIONAL PROVIDER IDENTIFIER |
| 15 | 7372256 | OTHER | MASSACHUSETTS | AETNA MA |
| 16 | 3694205 | OTHER | MASSACHUSETTS | AETNA, US HEALTHCARE |
| 17 | 712059 | OTHER | MASSACHUSETTS | TUFTS |
| 18 | NP415101 | OTHER | MASSACHUSETTS | MEDICARE |
| 19 | 2001781 | MEDICAID | MASSACHUSETTS | |
| 20 | 000000044649 | OTHER | MASSACHUSETTS | BOSTON MEDICAL CENTER |
| 21 | 1245229384 | OTHER | MASSACHUSETTS | NEIGHBORHOOD HEALTH PLAN |
| 22 | AA84681 | OTHER | MASSACHUSETTS | HARVARD PILGRIM |
| 23 | 1245229384 | OTHER | RHODE ISLAND | BCBS RI |
| 24 | 964850-01 | OTHER | MASSACHUSETTS | NETWORK HEALTH |
| 25 | 010460 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN |
| 26 | 1316922149 | OTHER | RHODE ISLAND | BLUE CHIP RI (HMO)/BLUE CROSS BLUE SHIELD OF RI |
| 27 | 29247-6 | OTHER | MASSACHUSETTS | RHODE ISLAND BLUE CROSS BLUE SHIELD |
| 28 | AA98069 | OTHER | MASSACHUSETTS | PILGRIM HEALTH CARE |
| 29 | A39686 | MEDICARE PIN | MASSACHUSETTS | |
| 30 | 1790880490 | OTHER | MASSACHUSETTS | BOSTON MEDICAL CENTER |
| 31 | 96427402 | OTHER | MASSACHUSETTS | NETWORK HEALTH |
| 32 | G56272 | MEDICARE UPIN | MASSACHUSETTS | |
| 33 | J18522 | OTHER | MASSACHUSETTS | BLUECROSS/BLUE SHIELD OF MASS |
| 34 | 408537 | OTHER | MASSACHUSETTS | BLUE CHIP OF R.I. |
| 35 | A39797 | MEDICARE PIN | MASSACHUSETTS | |
| 36 | HX4038 | MEDICARE PIN | MASSACHUSETTS | |
| 37 | 1245229384 | OTHER | MASSACHUSETTS | CELTICARE HEALTH PLAN OF MASS |
| 38 | 68741 | OTHER | MASSACHUSETTS | HARVARD PILGRIM |
| 39 | J23685 | OTHER | MASSACHUSETTS | BCBS MA |
| 40 | 6601003 | OTHER | MASSACHUSETTS | UNITED HEALTHCARE OF N.E. |
| 41 | NP415101 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD OF MA |
| 42 | 2019540 | MEDICAID | MASSACHUSETTS | |
| 43 | 9709860 | MEDICAID | MASSACHUSETTS | |
| 44 | 0X1477 | MEDICARE PIN | MASSACHUSETTS | |
| 45 | M21655 | MEDICARE PIN | MASSACHUSETTS | |