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 | | 79974 | 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 | 1059645 | OTHER | | FIRST HEALTH |
| 2 | 26785 | OTHER | | HEALTHY START |
| 3 | J14923 | OTHER | | BLUE SHIELD HMO BLUE |
| 4 | J14923 | OTHER | | MEDICARE B |
| 5 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 6 | 784248 | OTHER | | MVP HEALTH CARE |
| 7 | 991129 | OTHER | | FALLON COMMUNITY HEALTH P |
| 8 | 3131416 | MEDICAID | MASSACHUSETTS | |
| 9 | 2486213 | OTHER | | AETNA US HEALTHCARE |
| 10 | 4061873 | OTHER | | CIGNA HEALTH PLAN |
| 11 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 12 | J14923 | OTHER | | BLUE SHIELD INDEMNITY |
| 13 | AA1282 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 14 | 04011717 | OTHER | | EVERCARE |
| 15 | 042472266 | OTHER | | THREE RIVERS |
| 16 | 043058466 | OTHER | | HEALTHCARE VALUE MGMT |
| 17 | 26785 | OTHER | | CHILDRENS MED SEC PLAN |
| 18 | J14923 | OTHER | | BLUE CARE ELECT |
| 19 | F82581 | MEDICARE UPIN | | |
| 20 | J14923 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
