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 | 207Q00000X | Family Medicine | | 79019 | 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 | | PRIVATE HEALTHCARE SYSTEM |
| 2 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 3 | 1150399 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 4 | 7021289 | OTHER | | AETNA US HEALTHCARE |
| 5 | J14926 | OTHER | | BLUE SHIELD INDEMNITY |
| 6 | 3130690 | OTHER | | MEDICAID WELFARE |
| 7 | J14926 | OTHER | | BLUE CARE ELECT |
| 8 | J14926 | OTHER | | BLUE SHIELD HMO BLUE |
| 9 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 10 | 2759750 | OTHER | | CIGNA HEALTH PLAN |
| 11 | 784210 | OTHER | | MVP HEALTH CARE |
| 12 | 9901113 | OTHER | | FALLON COMMUNITY HEALTH P |
| 13 | 26971 | OTHER | | HEALTHY START |
| 14 | J14926 | OTHER | | MEDICARE B |
| 15 | 0100298 | OTHER | | EVERCARE |
| 16 | 26971 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 17 | 3130690 | MEDICAID | MASSACHUSETTS | |
| 18 | 042472266 | OTHER | | RAILROAD MEDICARE |
