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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 158828 | MASSACHUSETTS | No |
| 2 | 207RC0001X | Internal Medicine | Clinical Cardiac Electrophysiology | 158828 | 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 | 6549987 | OTHER | | CIGNA HEALTH PLAN |
| 3 | P00035681 | OTHER | | RAILROAD MEDICARE |
| 4 | 67548 | OTHER | | FALLON COMMUNITY HEALTH |
| 5 | 2007304 | MEDICAID | MASSACHUSETTS | |
| 6 | 51145 | OTHER | | CHILDRENS MED SECURITY |
| 7 | AA2846 | OTHER | | HARVARD PILGRIM |
| 8 | A34250 | OTHER | | MEDICARE B |
| 9 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 10 | 1358263 | OTHER | | FIRST HEALTH |
| 11 | 637897 | OTHER | MASSACHUSETTS | TUFTS |
| 12 | 784024 | OTHER | | MVP HEALTH CARE |
| 13 | 95651801 | OTHER | MASSACHUSETTS | NETWORK HEALTH |
| 14 | M19460 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD |
| 15 | F81633 | MEDICARE UPIN | | |
| 16 | A34250 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 17 | 2501190 | OTHER | | EVERCARE |
| 18 | 5009051 | OTHER | | AETNA US HEALTHCARE |
| 19 | 51145 | OTHER | | HEALTHY START |