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 | 22221 | CONNECTICUT | 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 | 060054 | OTHER | CONNECTICUT | HEALTH NET PROV ID |
| 2 | B83279 | MEDICARE UPIN | | |
| 3 | 01022221 | OTHER | CONNECTICUT | CIGNA PROV ID |
| 4 | 004062394 | MEDICAID | CONNECTICUT | |
| 5 | P369967 | OTHER | CONNECTICUT | OXFORD PROV ID |
| 6 | 71141 | OTHER | CONNECTICUT | AETNA REF ID |
| 7 | 1255448155 | OTHER | CONNECTICUT | GHMC GRP NPI ID |
| 8 | 5405001 | OTHER | CONNECTICUT | CONNECTICARE PROV ID |
| 9 | 010022221CT01 | OTHER | CONNECTICUT | BCBS N BCFP PROV ID |
| 10 | C01373 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | GHMC GRP MEDICARE ID |
| 11 | 367630 | OTHER | CONNECTICUT | WELLCARE MEDICARE |
| 12 | 001222215 | MEDICAID | CONNECTICUT | |
| 13 | 912454 | OTHER | CONNECTICUT | HEALTH NET REF ID |
| 14 | 100000072 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
