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 | 207RP1001X | Internal Medicine | Pulmonary Disease | 029502 | CONNECTICUT | 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 | 29151 | OTHER | | CONNECTICARE |
| 2 | 132830 | OTHER | | PREFERRED ONE HEALTHCARE |
| 3 | A61458 | MEDICARE UPIN | | |
| 4 | 0464894 | OTHER | | CIGNA HEALTHCARE |
| 5 | 3341765 | OTHER | | AETNA US HEALTHCARE MASTE |
| 6 | CT029502 | OTHER | | UNITED HEALTHCARE |
| 7 | 010029502CT03 | OTHER | CONNECTICUT | BLUE SHIELD |
| 8 | 329502 | OTHER | | CONNECTICARE |
| 9 | 290000292 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
| 10 | 030970 | OTHER | | HEALTH NET |
| 11 | 01809681 | MEDICAID | NEW YORK | |
| 12 | 001295022 | MEDICAID | CONNECTICUT | |
| 13 | 0000172 | MEDICAID | RHODE ISLAND | |
| 14 | 29925 | OTHER | | OXFORD HEALTH PLAN |
| 15 | 202374 | MEDICAID | NEW HAMPSHIRE | |
| 16 | 212874 | MEDICAID | RHODE ISLAND | |
| 17 | 290000292 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 18 | 290000231 | MEDICARE ID-TYPE UNSPECIFIED | | RAILROAD MEDICARE |
| 19 | NLP046 | OTHER | | OXFORD HEALTH PLAN |
| 20 | 85911 | MEDICAID | NEW YORK | |
