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 | | 047010 | CONNECTICUT | No |
| 2 | 208600000X | Surgery | | 238858 | NEW YORK | No |
| 3 | 2086X0206X | Surgery | Surgical Oncology | 047010 | CONNECTICUT | No |
| 4 | 2086X0206X | Surgery | Surgical Oncology | 238858 | NEW YORK | No |
| 5 | 2086X0206X | Surgery | Surgical Oncology | 88681 | SOUTH CAROLINA | No |
| 6 | 2086X0206X | Surgery | Surgical Oncology | MD487631 | PENNSYLVANIA | No |
| 7 | 208600000X | Surgery | | 78112 | MINNESOTA | 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 | 010047010CT01 | OTHER | CONNECTICUT | ANTHEM BCBS |
| 2 | 02770854 | MEDICAID | NEW YORK | |
| 3 | 06-1406459 | OTHER | CONNECTICUT | PRIVATE HEALTHCARE SYSTEMS |
| 4 | 7966939 | OTHER | CONNECTICUT | AETNA |
| 5 | 06-1406459 | OTHER | CONNECTICUT | MULTIPLAN |
| 6 | 06-1406459 | OTHER | CONNECTICUT | GREAT WEST HEALTHCARE |
| 7 | P3936800 | OTHER | CONNECTICUT | OXFORD |
| 8 | 0303481 | OTHER | CONNECTICUT | CIGNA |
| 9 | 06-1406459 | OTHER | CONNECTICUT | UNITED HEALTHCARE |
| 10 | 06-1406459 | OTHER | CONNECTICUT | WELLCARE |
| 11 | 06-1406459 | OTHER | CONNECTICUT | PIONEER |
| 12 | 06-1406459 | OTHER | CONNECTICUT | NORTHEAST HEALTH DIRECT |
| 13 | 06-1406459 | OTHER | CONNECTICUT | COMMUNITY HEALTH NETWORK |
| 14 | 06-1406459 | OTHER | CONNECTICUT | TRICARE |
| 15 | 1528012408 | MEDICAID | CONNECTICUT | |
| 16 | 047010 | OTHER | CONNECTICUT | CONNECTICARE |
| 17 | 3V1366 | OTHER | CONNECTICUT | HEALTH NET |
| 18 | 44721 | OTHER | CONNECTICUT | HEALTH NEW ENGLAND |
