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 | 207RH0000X | Internal Medicine | Hematology | 40628 | 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 | D83085 | MEDICARE UPIN | | |
| 2 | 042472266 | OTHER | | HEALTHCARE VALUE |
| 3 | 27530 | OTHER | | CHILDRENS MEDICALSECURITY |
| 4 | 1266084 | OTHER | | CIGNA HEALTH PLAN |
| 5 | N01713 | OTHER | | BLUE CARE ELECT |
| 6 | 04-2472266 | OTHER | | THREE RIVERS |
| 7 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 8 | 4385559 | OTHER | | AETNA US HEALTHCARE |
| 9 | 9900270 | OTHER | | FALLON COMMUNITY HEALTH |
| 10 | N01713 | OTHER | | BLUE SHIELD INDEMNITY |
| 11 | 04-2472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 12 | 040628 | OTHER | | TUFTS HEALTH PLAN |
| 13 | 1060864 | OTHER | | FIRST HEALTH |
| 14 | N01713 | OTHER | | MEDICARE B |
| 15 | 27530 | OTHER | | HEALTHY SMART |
| 16 | 784228 | OTHER | | MVP HEALTH CARE |
| 17 | AA3714 | OTHER | | HARVARD PILGRIM |
| 18 | N01713 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 19 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 20 | 830005042 | OTHER | | RAILROAD MEDICARE |
