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 | | 80679 | 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 | 0016057 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 2 | 080679 | OTHER | | TUFTS TOTAL HEALTH PLAN |
| 3 | 1240487 | OTHER | | UNITED HEALTHCARE (PPO) |
| 4 | 3138551 | OTHER | | MASS HEALTH(DIV OF MED SV |
| 5 | 200982 | OTHER | | HARVARD/PILGRIM |
| 6 | G03374 | MEDICARE UPIN | | |
| 7 | J31498 | OTHER | | HMO BLUE/BLUE CHOICE |
| 8 | 080679 | OTHER | | TUFTS COMMONWEALTH PPO |
| 9 | 27359 | OTHER | | CHILDREN'S MEDICAL SECURI |
| 10 | J31498 | OTHER | | BLUE SHIELD INDEMNITY |
| 11 | 200982 | OTHER | | HARVARD PILGRIM POS |
| 12 | 200982 | OTHER | | HARVARD PILGRIM PPO |
| 13 | 080679 | OTHER | | TUFTS |
| 14 | G03374 | OTHER | | FIRST SENIORITY |
| 15 | 080679 | OTHER | | TUFTS BENEFIT ADMIN |
| 16 | A20031 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 17 | 5400890 | OTHER | | CIGNA HEALTH CARE |
| 18 | 5400890 | OTHER | | HEALTHSOURCE MASSACHUSETT |
| 19 | J31498 | OTHER | | BS-BLUE CARE ELECT |
