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 | | 44970 | 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 | E33015 | OTHER | | BLUE SHIELD INDEMNITY |
| 2 | 04-00962 | OTHER | | EVERCARE |
| 3 | 9900056 | OTHER | | FALLON COMMUNITY HEALTH |
| 4 | E33015 | OTHER | | BLUE CARE ELECT |
| 5 | E33015 | OTHER | | BLUE SHIELD HMO BLUE |
| 6 | B73911 | MEDICARE UPIN | | |
| 7 | 04-3058466 | OTHER | | THREE RIVERS |
| 8 | 043058466 | OTHER | | TRICARE/CHAMPUS |
| 9 | 4034914 | OTHER | | AETNA US HEALTHCARE |
| 10 | 9111503 | OTHER | | CIGNA HEALTH PLAN |
| 11 | E33015 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 12 | 04/24/72266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 13 | 044970 | OTHER | | TUFTS HEALTH PLAN |
| 14 | 043058466 | OTHER | | HEALTHCARE VALUE |
| 15 | AA1252 | OTHER | | HARVARD PILGRIM |
| 16 | 110048770 | OTHER | | RAILROAD MEDICARE |
| 17 | 1583439 | OTHER | | FIRST HEALTH |
| 18 | 27064 | OTHER | | CHILDRENS MEDICAL |
| 19 | 27064 | OTHER | | HEALTHY START |
| 20 | 784245 | OTHER | | MVP HEALTH CARE |
