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 | 207RX0202X | Internal Medicine | Medical Oncology | 029598 | CONNECTICUT | 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 | 367807 | OTHER | CONNECTICUT | WELLCARE MEDICARE |
| 2 | B98886 | MEDICARE UPIN | | |
| 3 | C01373 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | GHMC GROUP MEDICARE ID |
| 4 | 4377459 | OTHER | CONNECTICUT | AETNA REF ID |
| 5 | HAS407 | OTHER | CONNECTICUT | HEALTH NET PROV ID |
| 6 | 1255448155 | OTHER | CONNECTICUT | GHMC GROUP NPI |
| 7 | 2V3633 | OTHER | CONNECTICUT | HEALTH NET PROV ID |
| 8 | 001295981 | MEDICAID | CONNECTICUT | |
| 9 | 720988 | OTHER | CONNECTICUT | CONNECTICARE PROV ID |
| 10 | 0029365 | OTHER | CONNECTICUT | CIGNA PROV ID |
| 11 | 010029598CT02 | OTHER | CONNECTICUT | BCBS N BCFP PROV ID |
| 12 | B98886 | MEDICARE UPIN | CONNECTICUT | |
| 13 | 830000127 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
| 14 | 004062394 | MEDICAID | CONNECTICUT | |
