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 | 207UN0901X | Nuclear Medicine | Nuclear Cardiology | 4706 | NEW HAMPSHIRE | No |
| 2 | 207R00000X | Internal Medicine | | 4706 | NEW HAMPSHIRE | No |
| 3 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 4706 | NEW HAMPSHIRE | 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 | 1982 | OTHER | NEW HAMPSHIRE | HEALTHSOURCE |
| 2 | 788361 | OTHER | NEW HAMPSHIRE | MVP HEALTHCARE |
| 3 | NH9562 | MEDICARE PIN | NEW HAMPSHIRE | |
| 4 | 406714 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN |
| 5 | D03518 | OTHER | NEW HAMPSHIRE | HARVARD PILGRIM |
| 6 | 110136126 | OTHER | NEW HAMPSHIRE | RAILROAD MEDICARE |
| 7 | P382048 | OTHER | NEW HAMPSHIRE | OXFORD HEALTH |
| 8 | 0108505YPNH01 | OTHER | NEW HAMPSHIRE | ANTHEM BLUE CROSS |
| 9 | 00000351 | MEDICAID | NEW HAMPSHIRE | |
| 10 | 930953 | OTHER | NEW HAMPSHIRE | AETNA HEALTH CARE |
| 11 | D03518 | MEDICARE UPIN | | |
