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 | 208000000X | Pediatrics | | 156420 | 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 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 2 | 3181740 | OTHER | | HEALTHY START |
| 3 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 4 | 2039844 | OTHER | | FIRST HEALTH |
| 5 | 33750 | OTHER | | FALLON COMMUNITY HEALTH P |
| 6 | 784160 | OTHER | | MVP HEALTH CARE |
| 7 | J19162 | OTHER | | BLUE SHIELD IDEMNITY |
| 8 | J19162 | OTHER | | BLUE CARE ELECT |
| 9 | 042472266 | OTHER | | THREE RIVERS |
| 10 | 110059991A | MEDICAID | MASSACHUSETTS | |
| 11 | AA1258 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 12 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 13 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 14 | 7689513 | OTHER | | AETNA US HEALTHCARE |
| 15 | J19162 | OTHER | | BLUE SHIELD HMO BLUE |
| 16 | 8681031 | OTHER | | CIGNA HEALTH PLAN |
| 17 | 37276 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 18 | A28407 | OTHER | | MEDICARE B |
