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 | 208600000X | Surgery | | 158969 | 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 | 158969 | OTHER | | TUFTS |
| 2 | 158969 | OTHER | | TUFTS SECURE HORIZONS |
| 3 | 802390 | OTHER | | HARVARD PILGRIM PPO |
| 4 | J21147 | OTHER | | HMO BLUE/BLUE CHOICE |
| 5 | 0023535 | OTHER | | NEIGHBORHOOD HEALTH |
| 6 | 158969 | OTHER | | TUFTS BENEFIT ADMINISTRAT |
| 7 | 802390 | OTHER | | HARVARD PILGRIM POS |
| 8 | 802390 | OTHER | | HARVARD PILGRIM |
| 9 | 158969 | OTHER | | TUFTS COMMONWEALTH PPO |
| 10 | 40043 | OTHER | | CHILDREN'S MED SECURITY |
| 11 | 158969 | OTHER | | TUFTS TOTAL HEALTH PLAN |
| 12 | 3191117 | OTHER | | MASS HEALTH |
| 13 | J21147 | OTHER | | BS-BLUE CARE ELECT |
| 14 | G86554 | MEDICARE UPIN | | |
| 15 | 802390 | OTHER | | FIRST SENIORITY |
| 16 | 8167125 | OTHER | MASSACHUSETTS | HEALTHSOURCE |
| 17 | J21147 | OTHER | | BLUE SHIELD INDEMNITYY |
| 18 | 020053191 | OTHER | | RAILROAD MEDICARE |
| 19 | A29161 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 20 | 8167125 | OTHER | | CIGNA HEALTH CARE |
