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 | 208000000X | Pediatrics | | 48564 | 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 | | HEALTHCARE VALUE MGMT |
| 2 | E13680 | MEDICARE UPIN | | |
| 3 | B28053 | OTHER | | BLUE CARE ELECT |
| 4 | 0186457 | MEDICAID | MASSACHUSETTS | |
| 5 | 042472266 | OTHER | | THREE RIVERS |
| 6 | B28053 | OTHER | | MEDICARE B |
| 7 | B28053 | OTHER | | BLUE SHIELD INDEMNITY |
| 8 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 9 | 5621538 | OTHER | | CIGNA HEALTH PLAN |
| 10 | 7503630 | OTHER | | AETNA US HEALTHCARE |
| 11 | AA1255 | OTHER | | HARVARD PILGRIM HEALTH |
| 12 | 0186457 | OTHER | | MEDICAID WELFARE |
| 13 | 9900092 | OTHER | | FALLON COMMUNITY HEALTH |
| 14 | B28053 | OTHER | | BLUE SHIELD HMO BLUE |
| 15 | 27058 | OTHER | | HEALTHY START |
| 16 | 2039843 | OTHER | | FIRST HEALTH |
| 17 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 18 | 27058 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 19 | 784190 | OTHER | | MVP HEALTH CARE |
| 20 | B28053 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
