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 | 207R00000X | Internal Medicine | | 79784 | 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 | 0400887 | OTHER | | EVERCARE |
| 2 | 991266 | OTHER | | FALLON COMMUNITY HEALTH |
| 3 | J14967 | OTHER | | BLUE SHIELD INDEMNITY |
| 4 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 5 | 0071113 | OTHER | | CIGNA HEALTH PLAN |
| 6 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 7 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 8 | 042472266 | OTHER | | THREE RIVERS |
| 9 | J14967 | OTHER | | BLUE CARE ELECT |
| 10 | 4589913 | OTHER | | AETNA US HEALTHCARE |
| 11 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 12 | 3134377 | MEDICAID | MASSACHUSETTS | |
| 13 | AA9890 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 14 | 2040310 | OTHER | | FIRST HEALTH |
| 15 | 380001156 | OTHER | | RAILROAD MEDICARE |
| 16 | J14967 | OTHER | | BLUE SHIELD HMO BLUE |
| 17 | 784028 | OTHER | | MVP HEALTH CARE |
