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 | 2086S0129X | Surgery | Vascular Surgery | 38493 | 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 | C07085 | OTHER | | BLUE SHIELD INDEMNITY |
| 2 | C07085 | OTHER | | BLUE CARE ELECT |
| 3 | C07085 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 4 | 784047 | OTHER | | MVP HEALTH CARE |
| 5 | 9900024 | OTHER | | FALLON COMMUNITY HEALTH P |
| 6 | A40660 | MEDICARE UPIN | | |
| 7 | 7310881 | OTHER | | CIGNA HEALTH PLAN |
| 8 | C07085 | OTHER | | BLUE SHIELD HMO BLUE |
| 9 | 26846 | OTHER | | HEALTHY START |
| 10 | 2041634 | MEDICAID | MASSACHUSETTS | |
| 11 | 7156308 | OTHER | | AETNA US HEALTHCARE |
| 12 | 917931 | OTHER | | FIRST HEALTH |
| 13 | 26846 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 14 | AA13526 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 15 | C07085 | OTHER | | MEDICARE B |
| 16 | 2041634 | OTHER | | MEDICAID WELFARE |
| 17 | 1700200 | OTHER | | EVERCARE |
