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 | 208000000X | Pediatrics | | 79030 | 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 | 042472266 | OTHER | | THREE RIVERS |
| 2 | 043058466 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 3 | 4674196 | OTHER | | AETNA US HEALTHCARE |
| 4 | 916010 | OTHER | | FIRST HEALTH |
| 5 | J14820 | OTHER | | MEDICARE B |
| 6 | J14820 | OTHER | | BLUE SHIELD INDEMNITY |
| 7 | J14820 | OTHER | | BLUE CARE ELECT |
| 8 | 043058466 | OTHER | | TRICARE CHAMPUS |
| 9 | 3128989 | OTHER | | WELFARE |
| 10 | AA1166 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 11 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 12 | 2040544 | OTHER | | CIGNA HEALTH PLAN |
| 13 | 26835 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 14 | 991102 | OTHER | | FALLON COMMUNITY HEALTH P |
| 15 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 16 | 3128989 | MEDICAID | MASSACHUSETTS | |
| 17 | 784234 | OTHER | | MVP HEALTH CARE |
| 18 | J14820 | OTHER | | BLUE SHIELD HMO BLUE |
