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 | 208000000X | Pediatrics | | 74156 | MASSACHUSETTS | 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 | 29198 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 2 | 042472266 | OTHER | | THREE RIVERS |
| 3 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 4 | 29198 | OTHER | | HEALTHY START |
| 5 | 784150 | OTHER | | MVP HEALTH CARE |
| 6 | J12537 | OTHER | | BLUE SHIELD INDEMNITY |
| 7 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 8 | 9900829 | OTHER | | FALLON COMMUNITY HEALTH P |
| 9 | 7157271 | OTHER | | AETNA US HEALTHCARE |
| 10 | AA1174 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 11 | J12537 | OTHER | | MEDICARE B |
| 12 | 7538260 | OTHER | | CIGNA |
| 13 | 917826 | OTHER | | FIRST HEALTH |
| 14 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 15 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 16 | 740020 | OTHER | | TUFTS HEALTH PLAN |
| 17 | J12537 | OTHER | | BLUE SHIELD HMO BLUE |
| 18 | J12537 | OTHER | | BLUE CARE ELECT |
