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 | 207R00000X | Internal Medicine | | 35867 | 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 | E33011 | OTHER | | MEDICARE B |
| 2 | 042472266 | OTHER | | THREE RIVERS |
| 3 | E33011 | OTHER | | BLUE CARE ELECT |
| 4 | 2634567 | OTHER | | AETNA US HEALTHCARE |
| 5 | 784249 | OTHER | | MVP HEALTH CARE |
| 6 | E33011 | OTHER | | BLUE SHIELD HMO BLUE |
| 7 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 8 | 3289040 | OTHER | | CIGNA HEALTH PLAN |
| 9 | E33011 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 10 | 043058466 | OTHER | | HEALTHCARE VALUE MGMT |
| 11 | 0402099 | OTHER | | EVERCARE |
| 12 | E33011 | OTHER | | BLUE SHIELD INDEMNITY |
| 13 | 1059663 | OTHER | | FIRST HEALTH |
| 14 | AA1297 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 15 | 3099059 | MEDICAID | MASSACHUSETTS | |
| 16 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 17 | 110221136 | OTHER | | RAILROAD MEDICARE |
| 18 | 26787 | OTHER | | CHILDRENS MED SEC PLAN |
| 19 | 26787 | OTHER | | HEALTHY START |
| 20 | B73907 | MEDICARE UPIN | | |
