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 | 174400000X | Specialist | | RI00487 | RHODE ISLAND | No |
| 2 | 174400000X | Specialist | | D0487 | RHODE ISLAND | No |
| 3 | 174400000X | Specialist | | DO00487 | RHODE ISLAND | 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 | 022429386 | OTHER | RHODE ISLAND | UNITED HEALTHCARE |
| 2 | 8177408002 | OTHER | RHODE ISLAND | CIGNA |
| 3 | DN3002 | OTHER | RHODE ISLAND | RAILROAD MEDICARE |
| 4 | 1805526 | OTHER | RHODE ISLAND | UNITED HEALTHCARE |
| 5 | 7716215 | OTHER | RHODE ISLAND | AETNA US HEALTHCARE |
| 6 | 2969061 | OTHER | RHODE ISLAND | UNITED HEALTHCARE |
| 7 | TC72651 | MEDICAID | RHODE ISLAND | |
| 8 | 9021255 | MEDICAID | RHODE ISLAND | |
| 9 | 00000277938 | OTHER | RHODE ISLAND | BLUE SHIELD |
| 10 | 794230 | OTHER | RHODE ISLAND | TUFTS HEALTH PLAN |
| 11 | 349021255 | MEDICARE PIN | RHODE ISLAND | |
| 12 | 10246 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH PLAN |
| 13 | 402643 | OTHER | RHODE ISLAND | BLUE CROSS & BLUE SHIELD OF RI |
| 14 | 7716215 | OTHER | RHODE ISLAND | AETNA |
| 15 | AA38818 | OTHER | RHODE ISLAND | HARVARD PILGRIM HEALTHCARE |
| 16 | 10246 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH PLAN OF RI |
| 17 | G71239 | MEDICARE UPIN | RHODE ISLAND | |
| 18 | 349006065 | MEDICARE PIN | RHODE ISLAND | |
