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 | 2085R0202X | Radiology | Diagnostic Radiology | MD03913 | RHODE ISLAND | No |
| 2 | 2085U0001X | Radiology | Diagnostic Ultrasound | MD03913 | RHODE ISLAND | 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 | 003913 | OTHER | RHODE ISLAND | TUFTS TGR |
| 2 | 1198-5 | OTHER | RHODE ISLAND | BCBS TGR OFFICE |
| 3 | 7008831 | MEDICAID | RHODE ISLAND | |
| 4 | 7111640 | OTHER | RHODE ISLAND | AETNA TGR OFFICE |
| 5 | 0193551 | MEDICAID | MASSACHUSETTS | |
| 6 | 1570-5 | OTHER | RHODE ISLAND | TGR KENT |
| 7 | 2203 | OTHER | RHODE ISLAND | NHP TGR |
| 8 | 27045 | OTHER | MASSACHUSETTS | MA LICENSE |
| 9 | 16-00137 | OTHER | RHODE ISLAND | UHC |
| 10 | P00180550 | OTHER | RHODE ISLAND | BCBS TGR |
| 11 | 408889 | OTHER | RHODE ISLAND | BLUE CHIP TGR |
| 12 | 756624 | OTHER | RHODE ISLAND | CONNECTICARE TGR |
| 13 | MD03913 | OTHER | RHODE ISLAND | RI LICENSE |
