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 | 213E00000X | Podiatrist | | 2068 | MASSACHUSETTS | No |
| 2 | 213E00000X | Podiatrist | | 303 | RHODE ISLAND | No |
| 3 | 213E00000X | Podiatrist | | DPM 303 | RHODE ISLAND | No |
| 4 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | 303 | RHODE ISLAND | No |
| 5 | 213ES0103X | Podiatrist | Foot & Ankle Surgery | 2068 | 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 | 003360201 | OTHER | MASSACHUSETTS | MEDICARE PTAN |
| 2 | 0660120001 | OTHER | RHODE ISLAND | DME SUPPLIER NUMBER |
| 3 | 27-02444 | OTHER | RHODE ISLAND | UNITED HEALTH CARE |
| 4 | 9080028 | MEDICAID | RHODE ISLAND | |
| 5 | 454919 | OTHER | RHODE ISLAND | TUFTS |
| 6 | U67277 | MEDICARE UPIN | | |
| 7 | 0000002410 | OTHER | RHODE ISLAND | B/C |
| 8 | 480032461 | OTHER | RHODE ISLAND | RAILROAD MEDICARE |
| 9 | 334210 | OTHER | RHODE ISLAND | HARVARD PILGRIM HEALTH |
| 10 | 408233 | OTHER | RHODE ISLAND | BCHIP |
| 11 | 489080028 | MEDICARE PIN | RHODE ISLAND | |
| 12 | 110094952A | MEDICAID | MASSACHUSETTS | |
| 13 | 4211 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH |
