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 | 261Q00000X | Clinic/Center | | | | No |
| 2 | 207Q00000X | Family Medicine | | | | No |
| 3 | 207RX0202X | Internal Medicine | Medical Oncology | | | No |
| 4 | 2084N0400X | Psychiatry & Neurology | Neurology | | | No |
| 5 | 207V00000X | Obstetrics & Gynecology | | | | No |
| 6 | 207X00000X | Orthopaedic Surgery | | | | No |
| 7 | 2084P0800X | Psychiatry & Neurology | Psychiatry | | | No |
| 8 | 207RP1001X | Internal Medicine | Pulmonary Disease | | | No |
| 9 | 208600000X | Surgery | | | | No |
| 10 | 207PE0005X | Emergency Medicine | Undersea and Hyperbaric Medicine | | | No |
| 11 | 208800000X | Urology | | | | No |
| 12 | 207RE0101X | Internal Medicine | Endocrinology, Diabetes & Metabolism | | | No |
| 13 | 208000000X | Pediatrics | | | | No |
| 14 | 208200000X | Plastic Surgery | | | | No |
| 15 | 282N00000X | General Acute Care Hospital | | 36286 | MAINE | 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 | 10022603 | OTHER | | CAPITAL DISTRICT PHYSICIA |
| 2 | 200020 | OTHER | | BCNH ANESTHESIA |
| 3 | 900273 | OTHER | | HARVARD PILGRIM |
| 4 | BCNH ONCOLOGY | OTHER | | 200020 |
| 5 | 800373 | OTHER | | BCNH CARDIAC |
| 6 | 003023157 | OTHER | | MEDICAID CONNECTICUT OP |
| 7 | 62463 | OTHER | | AETNA |
| 8 | IYOK200020 | OTHER | | MATTHEW THORNTON BLUE |
| 9 | 921444 | OTHER | | CONNECTICARE |
| 10 | 200020 | OTHER | | BCNH IP AND OP |
| 11 | 200020 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 12 | 003031754 | OTHER | | MEDICAID CONNECTICUT IP |
| 13 | M10500 | OTHER | | CIGNA HEALTHSOURCE |
| 14 | 200020000054 | OTHER | | BCME BCMA |
| 15 | M10500 | OTHER | | CIGNA HEALTHSOURCE NH |
| 16 | 200020 | OTHER | | MATTHEW THORNTON HMO |
| 17 | 102100000 | MEDICAID | MAINE | |
| 18 | 200020 | OTHER | | BCNH ER |
| 19 | ========= | OTHER | | TRICARE |
| 20 | 99200020 | MEDICAID | NEW HAMPSHIRE | |
