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 | 207RH0003X | Internal Medicine | Hematology & Oncology | | | No |
| 2 | 207RR0500X | Internal Medicine | Rheumatology | | | No |
| 3 | 207V00000X | Obstetrics & Gynecology | | | | No |
| 4 | 207X00000X | Orthopaedic Surgery | | | | No |
| 5 | 207Y00000X | Otolaryngology | | | | No |
| 6 | 208000000X | Pediatrics | | | | No |
| 7 | 2080P0202X | Pediatrics | Pediatric Cardiology | | | No |
| 8 | 261QA1903X | Clinic/Center | Ambulatory Surgical | 02552 | NEW HAMPSHIRE | No |
| 9 | 261QR0200X | Clinic/Center | Radiology | | | No |
| 10 | 207K00000X | Allergy & Immunology | | | | No |
| 11 | 207N00000X | Dermatology | | | | No |
| 12 | 207R00000X | Internal Medicine | | | | No |
| 13 | 207RC0000X | Internal Medicine | Cardiovascular Disease | | | No |
| 14 | 207RG0100X | Internal Medicine | Gastroenterology | | | No |
| 15 | 207Q00000X | Family Medicine | | | | 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 | 301014 | MEDICARE PIN | NEW HAMPSHIRE | |
| 2 | CA4893 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 3 | CA6501 | OTHER | NEW HAMPSHIRE | RAILROAD |
| 4 | CA9427 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 5 | CE1581 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 6 | DC7903 | OTHER | NEW HAMPSHIRE | RAILROAD |
| 7 | CC1439 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 8 | CN1486 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 9 | CN3827 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 10 | 0000821 | MEDICAID | VERMONT | |
| 11 | CA0032 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 12 | CA5006 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 13 | 3080894 | MEDICAID | NEW HAMPSHIRE | |
| 14 | 0565280004 | MEDICARE NSC | NEW HAMPSHIRE | |
| 15 | NH9592 | MEDICARE PIN | NEW HAMPSHIRE | |
| 16 | CB9189 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 17 | 3080411 | MEDICAID | NEW HAMPSHIRE | |
| 18 | CA5651 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 19 | VT9589 | MEDICARE PIN | VERMONT | |
| 20 | DE5051 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 21 | 3081001 | MEDICAID | NEW HAMPSHIRE | |
