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 | 208200000X | Plastic Surgery | | 9401 | RHODE ISLAND | No |
| 2 | 208200000X | Plastic Surgery | | 036291 | CONNECTICUT | No |
| 3 | 208200000X | Plastic Surgery | | 75409 | MASSACHUSETTS | No |
| 4 | 2082S0099X | Plastic Surgery | Plastic Surgery Within the Head and Neck | 9401 | RHODE ISLAND | No |
| 5 | 2082S0099X | Plastic Surgery | Plastic Surgery Within the Head and Neck | 036291 | CONNECTICUT | No |
| 6 | 2082S0105X | Plastic Surgery | Surgery of the Hand | 9401 | RHODE ISLAND | No |
| 7 | 2082S0105X | Plastic Surgery | Surgery of the Hand | 036291 | CONNECTICUT | No |
| 8 | 2086S0122X | Surgery | Plastic and Reconstructive Surgery | 042.0013287 | VERMONT | 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 | 010075409RI01 | OTHER | CONNECTICUT | ANTHEM BC OF CT ID # |
| 2 | RI0846 | OTHER | RHODE ISLAND | HEALTHNET-NONPAR ID # |
| 3 | G36120 | MEDICARE UPIN | RHODE ISLAND | |
| 4 | 010036291CT01 | OTHER | CONNECTICUT | ANTHEM OF CT FEDERAL ID # |
| 5 | 20437-6 | OTHER | RHODE ISLAND | BCBS OF RI ID # |
| 6 | 401029 | OTHER | RHODE ISLAND | BCBCHIP OF RI ID # |
| 7 | 240000163 | MEDICARE ID-TYPE UNSPECIFIED | CONNECTICUT | |
| 8 | 249002670 | MEDICARE ID-TYPE UNSPECIFIED | RHODE ISLAND | |
| 9 | 061485169 | OTHER | | TAX IDENTIFICATION NUMBER |
