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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 24813 | 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 | P369914 | OTHER | CONNECTICUT | OXFORD PROV ID |
| 2 | 481462 | OTHER | CONNECTICUT | AETNA REF ID |
| 3 | C49033 | MEDICARE UPIN | | |
| 4 | 010024813CT01 | OTHER | CONNECTICUT | BCBS N BCFP PROV ID |
| 5 | 5004101 | OTHER | CONNECTICUT | CONNECTICARE PROV ID |
| 6 | 139484 | OTHER | CONNECTICUT | WELLCARE MEDICARE |
| 7 | 01908387 | OTHER | NEW YORK | NY MEDICAID |
| 8 | 060000737 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
| 9 | 1255448155 | OTHER | CONNECTICUT | GHMC GRP NPI ID |
| 10 | 001248137 | MEDICAID | CONNECTICUT | |
| 11 | 01024813 | OTHER | CONNECTICUT | CIGNA PROV ID |
| 12 | C01373 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | GHMC GRP MEDICARE ID |
| 13 | 004214459 | MEDICAID | CONNECTICUT | |
