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 | 207RX0202X | Internal Medicine | Medical Oncology | 12174 | NEW HAMPSHIRE | No |
| 2 | 207RX0202X | Internal Medicine | Medical Oncology | N0390 | TEXAS | Yes |
| 3 | 207RH0003X | Internal Medicine | Hematology & Oncology | N0390 | TEXAS | No |
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 | 30204446 | MEDICAID | NEW HAMPSHIRE | |
| 2 | P00185708 | OTHER | NEW HAMPSHIRE | RAIL ROAD MEDICARE |
| 3 | 083503501 | MEDICAID | TEXAS | |
| 4 | 5606733 | OTHER | NEW HAMPSHIRE | MAIL HANDLERS/FIRST HEALT |
| 5 | 414300099 | MEDICAID | MAINE | |
| 6 | 718774 | OTHER | NEW HAMPSHIRE | CIGNA NATIONAL |
| 7 | 5606733 | OTHER | NEW HAMPSHIRE | CCN HEALTH NETWORK |
| 8 | 7284653 | OTHER | NEW HAMPSHIRE | AETNA |
| 9 | 386543 | OTHER | NEW HAMPSHIRE | MVP HEALTH CARE |
| 10 | AA16418 | OTHER | NEW HAMPSHIRE | HARVARD PILGRIM |
| 11 | 01Y007451NH01 | OTHER | NEW HAMPSHIRE | BLUE CROSS/BLUE SHIELD |
| 12 | 1211019 | OTHER | NEW HAMPSHIRE | CIGNA/HEALTHSOURCE |
| 13 | 155217601 | MEDICAID | TEXAS | |
| 14 | 200784103 | MEDICAID | TEXAS | |