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 | 207RG0100X | Internal Medicine | Gastroenterology | 39361 | 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 | 1639174410 | OTHER | MASSACHUSETTS | FALLON COMMUNITY HEALTH PLAN |
| 2 | 976795 | OTHER | | NETWORK HEALTH |
| 3 | A54064 | MEDICARE UPIN | MASSACHUSETTS | |
| 4 | 678810 | OTHER | | HEALTHSOURCE |
| 5 | 30261 | OTHER | MASSACHUSETTS | HARVARD PILGRIM HEALTHCAR |
| 6 | D11109 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 7 | 039361 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN |
| 8 | 1639174410 | OTHER | MASSACHUSETTS | AETNA HMO |
| 9 | 2040646 | MEDICAID | MASSACHUSETTS | |
| 10 | 29-00574 | OTHER | | EVERCARE |
| 11 | 0011285 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 12 | 4035488 | OTHER | MASSACHUSETTS | AETNA NON HMO |
| 13 | A54064 | OTHER | NEVADA | ANTHEM BLUE CROSS |
| 14 | D11109 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD |
| 15 | 00000292 | OTHER | NEW HAMPSHIRE | NH MEDICAID |
| 16 | 100014709 | OTHER | | RAILROAD MEDICARE |
| 17 | 5919450 | OTHER | | CIGNA HEALTHCARE |
| 18 | 110036482A | MEDICAID | MASSACHUSETTS | |
