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 | | 9171 | NEW HAMPSHIRE | 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 | F67039 | MEDICARE UPIN | NEW HAMPSHIRE | |
| 2 | 30006964 | MEDICAID | NEW HAMPSHIRE | |
| 3 | 12-40732 | OTHER | NEW HAMPSHIRE | UHC PIN |
| 4 | 20169Y | OTHER | NEW HAMPSHIRE | ANTHEM REFERRING RAN |
| 5 | 2127 | OTHER | NEW HAMPSHIRE | CIGNA PIN |
| 6 | 0109657YPNH01 | OTHER | NEW HAMPSHIRE | ANTHEM ACES PIN |
| 7 | P667617 | OTHER | NEW HAMPSHIRE | OXFORD PIN |
| 8 | 406455 | OTHER | NEW HAMPSHIRE | TUFTS PIN |
| 9 | 2192446 | OTHER | NEW HAMPSHIRE | AETNA PIN |
| 10 | F67039 | OTHER | NEW HAMPSHIRE | HPHC |
| 11 | RE7565 | MEDICARE PIN | NEW HAMPSHIRE | |
