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 | 207N00000X | Dermatology | | 74595 | 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 | 3100545 | MEDICAID | MASSACHUSETTS | |
| 2 | 33316 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 3 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 4 | 0300126 | OTHER | | EVERCARE |
| 5 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 6 | 9900848 | OTHER | | FALLON COMMUNITY HEALTH P |
| 7 | AA4386 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 8 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 9 | 7852920 | OTHER | | CIGNA HEALTH PLAN |
| 10 | J12081 | OTHER | | BLUE SHIELD INDEMNITY |
| 11 | 1061446 | OTHER | | FIRST HEALTH |
| 12 | 33316 | OTHER | | HEALTHY START |
| 13 | J12081 | OTHER | | MEDICARE B |
| 14 | 3100545 | OTHER | | MEDICAID WELFARE |
| 15 | 784086 | OTHER | | MVP HEALTH CARE |
| 16 | J12081 | OTHER | | BLUE CARE ELECT |
| 17 | J12081 | OTHER | | BLUE SHIELD HMO BLUE |
| 18 | 5844188 | OTHER | | AETNA US HEALTHCARE |
