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 | 208100000X | Physical Medicine & Rehabilitation | | MD06749 | RHODE ISLAND | 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 | 22534 | OTHER | MASSACHUSETTS | HARVARD PILGRIM |
| 2 | 404632 | OTHER | MASSACHUSETTS | TUFTS |
| 3 | A59218 | MEDICARE UPIN | RHODE ISLAND | |
| 4 | 23-00080 | OTHER | RHODE ISLAND | UNITED HEALTH |
| 5 | 4197 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH PLAN |
| 6 | 7680569 | OTHER | RHODE ISLAND | COMMERCIAL |
| 7 | J06887 | OTHER | MASSACHUSETTS | MASS BLUE CROSS |
| 8 | 2567536 | OTHER | RHODE ISLAND | AETNA |
| 9 | J06887 | MEDICARE PIN | | |
| 10 | 8725377002 | OTHER | RHODE ISLAND | RI CIGNA |
| 11 | 3020185 | OTHER | MASSACHUSETTS | MASS HEALTH |
| 12 | 80579 | OTHER | RHODE ISLAND | RI HARVARD PILGRIM |
| 13 | 22166 | OTHER | RHODE ISLAND | BLUE CROSS OF RI |
| 14 | 23-00181 | OTHER | RHODE ISLAND | MEDICARE COMPLETE |
| 15 | 405187 | OTHER | RHODE ISLAND | BLUE CHIP |