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 | 2085N0904X | Radiology | Nuclear Radiology | 42854 | MASSACHUSETTS | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | 42854 | 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 | C05296 | OTHER | | BLUE SHIELD HMO BLUE |
| 2 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 3 | 1150178 | OTHER | | FIRST HEALTH |
| 4 | 28037 | OTHER | | HEALTHY START |
| 5 | 0143138 | OTHER | | WELFARE |
| 6 | 5910031 | OTHER | | AETNA US HEALTHCARE |
| 7 | 300087719 | MEDICARE ID-TYPE UNSPECIFIED | | RAILROAD |
| 8 | 28037 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 9 | B76630 | MEDICARE UPIN | | |
| 10 | C05296 | OTHER | | BLUE CARE ELECT |
| 11 | 042472266 | OTHER | | THREE RIVERS |
| 12 | 1760952 | OTHER | | CIGNA HEALTH PLAN |
| 13 | C05296 | MEDICARE ID-TYPE UNSPECIFIED | | B |
| 14 | AA4453 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 15 | 9900864 | OTHER | | FALLON COMMUNITY HEALTH P |
| 16 | C05296 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 17 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 18 | 784216 | OTHER | | MVP HEALTH CARE |
| 19 | 0143138 | MEDICAID | MASSACHUSETTS | |
| 20 | C05296 | OTHER | | BLUE SHIELD INDEMNITY |
