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 | 208000000X | Pediatrics | | 041150 | 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 | 041150 | OTHER | CONNECTICUT | CONNECTICARE |
| 2 | I49472 | MEDICARE UPIN | CONNECTICUT | |
| 3 | 370001629 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | INDIVIDUAL MEDICARE CT |
| 4 | 004195930 | MEDICAID | CONNECTICUT | |
| 5 | 2V7192 | OTHER | CONNECTICUT | HEALTH NET PROV ID |
| 6 | 040041150CT02 | OTHER | CONNECTICUT | BCBS N BCFP PROV ID |
| 7 | 2727699 | OTHER | CONNECTICUT | CIGNA PROV ID |
| 8 | 001411503 | MEDICAID | CONNECTICUT | |
| 9 | P3644959 | OTHER | CONNECTICUT | OXFORD PROV ID |
| 10 | 271383 | OTHER | CONNECTICUT | WELLCARE MEDICARE |
| 11 | C01373 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | GHMC GRP MEDICARE ID |
| 12 | 1255448155 | OTHER | CONNECTICUT | GHMC GRP NPI ID |
