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 | 207V00000X | Obstetrics & Gynecology | | 75676 | 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 | 10034446 | OTHER | | CAPITAL DISTRICT PHP |
| 2 | 3094561 | MEDICAID | MASSACHUSETTS | |
| 3 | 0000799 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 4 | 043517461 | OTHER | | HCVM FIRST HEALTH |
| 5 | 10540 | OTHER | | HEATH NEW ENGLAND |
| 6 | 160052693 | OTHER | | MEDICARE RAILROAD |
| 7 | 2345333 | OTHER | | AETNA |
| 8 | F29387 | OTHER | | HARVARD COMM HEALTH |
| 9 | J12595 | OTHER | | HMO BLUE |
| 10 | 043517461 | OTHER | | NO AMERICAN ADMIN |
| 11 | 153344 | OTHER | | MVP SELECT |
| 12 | 32596 | OTHER | | HEALTHY START |
| 13 | 80314 | OTHER | | GIC INDEMNITY PLAN |
| 14 | 000000022178 | OTHER | | BMC HEALTH NET PLAN |
| 15 | 043517461 | OTHER | | HMC PPO |
| 16 | 043517461 | OTHER | | CHAMPUS |
| 17 | J12595 | OTHER | | BLUE SHIELD |
| 18 | 043517461 | OTHER | | CIGNA |
| 19 | J12595 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 20 | F29387 | MEDICARE UPIN | | |
