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 | 207V00000X | Obstetrics & Gynecology | | 72659 | MASSACHUSETTS | No |
| 2 | 202K00000X | Phlebology | | 72659 | 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 | 072659 | OTHER | | TUFTS COMMONWEALTH PPO |
| 2 | 13725 | OTHER | | HARVARD PILGRIM PPO |
| 3 | 16003690 | OTHER | | RAILROAD/MEDICARE |
| 4 | NX4191 | MEDICARE PIN | MASSACHUSETTS | |
| 5 | J11407 | OTHER | | HMO BLUE/BLUE CHOICE |
| 6 | 13725 | OTHER | | HARVARD PILGRIM POS |
| 7 | 13725 | OTHER | | HARVARD/PILGRIM |
| 8 | 8186449 | OTHER | | HEALTHSOURCE MASS. |
| 9 | E93037 | MEDICARE UPIN | | |
| 10 | J11407 | OTHER | | BLUE SHIELD-INDEMNITY |
| 11 | 8186449 | OTHER | | CIGNA HEALTH CARE |
| 12 | J11407 | MEDICARE PIN | MASSACHUSETTS | |
| 13 | 07-00753 | OTHER | | UNITED HEALTHCARE HMO PPO |
| 14 | 072659 | OTHER | | TUFTS TOTAL HEALTH PLAN |
| 15 | E93037 | OTHER | | FIRST SENIORITY |
| 16 | 072659 | OTHER | | TUFTS |
| 17 | 27397 | OTHER | | CHILDREN'S MEDICAL SEC. |
| 18 | 0016762 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 19 | J11407 | OTHER | | BS- BLUE CARE ELECT |
| 20 | 072659 | OTHER | | TUFTS BENEFIT ADMIN. |
