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 | 207Q00000X | Family Medicine | | 1287 | 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 | 010467585 | OTHER | | STANDARD TAX ID |
| 2 | E10019 | OTHER | | HARVARD PILGRIM |
| 3 | 3646359 | OTHER | | CIGNA HEALTHCARE |
| 4 | 596163 | OTHER | | AETNA NONHMO GROUP |
| 5 | 283840099 | MEDICAID | MAINE | |
| 6 | E10019 | MEDICARE UPIN | | |
| 7 | MM2427 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 8 | YORK083565 | OTHER | | ANTHEM BCBS NEW HAMPSHIRE |
| 9 | 010467585 | OTHER | | MACHIGONNE |
| 10 | 080140515 | OTHER | | RAILROAD MEDICARE |
| 11 | 283840099 | OTHER | | PRIMECARE MEDICAID |
| 12 | 596163 | OTHER | | AETNA HMO GROUP |
| 13 | 003689 | OTHER | | ANTHEM BLUE CROSS BLUE SH |
| 14 | 010467585 | OTHER | | AETNA HMO |
| 15 | MM2427 | OTHER | | MEDICARE B |
| 16 | 010467585 | OTHER | | AETNA NONHMO |
| 17 | 0405236YPME01 | OTHER | | ANTHEM BCBS NEW HAMPSHIRE |
| 18 | 010467585 | OTHER | | CHAMPUS |
| 19 | 010467585001 | OTHER | | ANTHEM BLUE CROSS BLUE SH |
