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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 39310 | 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 | 4366873 | OTHER | | CIGNA HEALTH PLAN |
| 2 | N01759 | OTHER | | MEDICARE B |
| 3 | 5030238 | OTHER | | AETNA US HEALTHCARE |
| 4 | N01759 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 5 | 2070944 | MEDICAID | MASSACHUSETTS | |
| 6 | N01759 | OTHER | | BLUE SHIELD INDEMNITY |
| 7 | 26850 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 8 | N01759 | OTHER | | BLUE CARE ELECT |
| 9 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 10 | 060047286 | OTHER | | RAILROAD MEDICARE |
| 11 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 12 | 784067 | OTHER | | MVP HEALTH CARE |
| 13 | A67186 | MEDICARE UPIN | | |
| 14 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGMEN |
| 15 | 2070944 | OTHER | | MEDICAID WELFARE |
| 16 | AA6084 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 17 | N01759 | OTHER | | BLUE SHIELD HMO BLUE |
| 18 | 26856 | OTHER | | HEALTHY START |
| 19 | 918138 | OTHER | | FIRST HEALTH |
| 20 | 9900071 | OTHER | | FALLON COMMUNITY HEALTH P |
