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 | | 220491 | 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 | 042472266 | OTHER | | UNITED HEALTHCARE |
| 2 | 4094854 | OTHER | | AETNA US HEALTHCARE |
| 3 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 467892 | OTHER | | TUFTS HEALTH PLAN |
| 5 | 784025 | OTHER | | MVP HEALTH CARE |
| 6 | AA10928 | OTHER | | HARVARD PILGRIM |
| 7 | B81374 | MEDICARE UPIN | | |
| 8 | 042472266 | OTHER | | THREE RIVERS |
| 9 | 67982 | OTHER | | FALLON COMM HEALTH PLAN |
| 10 | 2037114 | MEDICAID | MASSACHUSETTS | |
| 11 | A37417 | MEDICARE PIN | MASSACHUSETTS | |
| 12 | J27427 | OTHER | | BLUE CARE ELECT |
| 13 | 4599158 | OTHER | | CIGNA HEALTH PLAN |
| 14 | J27427 | OTHER | | BLUE SHIELD INDEMNITY |
| 15 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 16 | 0406618 | OTHER | | EVERCARE |
| 17 | J27427 | OTHER | | BLUE SHIELD HMO BLUE |
| 18 | 2225093 | OTHER | | FIRST HEALTH |
