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 | 207RG0100X | Internal Medicine | Gastroenterology | 6818 | RHODE ISLAND | No |
| 2 | 207RG0100X | Internal Medicine | Gastroenterology | 49579 | 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 | 60398 | OTHER | | HARVARD PILGRIM IND |
| 2 | 49540 | OTHER | RHODE ISLAND | BLUE SHIELD |
| 3 | J24275 | OTHER | MASSACHUSETTS | BLUE SHIELD |
| 4 | E96991 | MEDICARE UPIN | | |
| 5 | A33381 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 6 | M15160 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 7 | 006818 | OTHER | | TUFTS IND |
| 8 | 9778446 | MEDICAID | MASSACHUSETTS | |
| 9 | 000000028617 | OTHER | | BMC HEALTHNET IND |
| 10 | 608470 | OTHER | | TUFTS GRP |
| 11 | 2721284002 | OTHER | | CIGNA IND |
| 12 | M16425 | OTHER | MASSACHUSETTS | BLUE SHIELD |
| 13 | 202033 | OTHER | | RI BLUE CHIP |
| 14 | 2900458 | OTHER | | IND UNITED HEALTH CARE |
| 15 | 52473 | OTHER | | FALLON IND |
| 16 | 0028271 | OTHER | | NEIGHBORHOOD HEALTH IND |
