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 | | 55880 | 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 | 0406756 | OTHER | | EVERCARE |
| 2 | J12763 | OTHER | | BLUE SHIELD HMO BLUE |
| 3 | 1150400 | OTHER | | FIRST HEALTH |
| 4 | 26981 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 5 | J12763 | OTHER | | BLUE SHIELD INDEMNITY |
| 6 | 7756324 | OTHER | | AETNA US HEALTHCARE |
| 7 | 784110 | OTHER | | MVP HEALTH CARE |
| 8 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 9 | 26981 | OTHER | | HEALTHY START |
| 10 | 3548184 | OTHER | | CIGNA HEALTHSOURCE |
| 11 | J12763 | MEDICARE ID-TYPE UNSPECIFIED | | B |
| 12 | 2040670004 | OTHER | | CIGNA PAL ID REFERAL |
| 13 | F33687 | MEDICARE UPIN | | |
| 14 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 15 | AA7085 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 16 | J12763 | OTHER | | BLUE CARE ELECT |
| 17 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 18 | 9900267 | OTHER | | FALLON COMMUNITY HEALTH |
| 19 | B201961011 | OTHER | | CIGNA HEALTH PLAN |
| 20 | J12763 | MEDICARE ID-TYPE UNSPECIFIED | | |
