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 | 208600000X | Surgery | | 210201 | MASSACHUSETTS | No |
| 2 | 2086S0129X | Surgery | Vascular Surgery | 210201 | 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 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 2 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 3 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 784058 | OTHER | | MVP HEALTH CARE |
| 5 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 6 | 0142701 | OTHER | | WELFARE |
| 7 | J23719 | OTHER | | BLUE CARE ELECT |
| 8 | H55639 | MEDICARE UPIN | | |
| 9 | A33606 | MEDICARE ID-TYPE UNSPECIFIED | | B |
| 10 | A33606 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 11 | 1927085 | OTHER | | FIRST HEALTH |
| 12 | 61247 | OTHER | | FALLON COMMUNITY HEALTH |
| 13 | 7258566 | OTHER | | AETNA US HEALTHCARE |
| 14 | 042472266 | OTHER | | THREE RIVERS |
| 15 | 3700073 | OTHER | | EVERCARE |
| 16 | J23719 | OTHER | | BLUE SHIELD HMO BLUE |
| 17 | 0142701 | OTHER | | HEALTHY START |
| 18 | J23719 | OTHER | | BLUE SHIELD INDEMNITY |
| 19 | 6272907 | OTHER | | CIGNA HEALTH PLAN |
| 20 | AA4381 | OTHER | | HARVARD PILGRIM HEALTHCAR |