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 | 207W00000X | Ophthalmology | | 58957 | 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 | 0063847 | OTHER | | CIGNA HEALTH CARE |
| 2 | 150709 | OTHER | | HARVARD PILGRIM PPO |
| 3 | 718195 | OTHER | | TUFTS BENEFIT ADMINSTRATO |
| 4 | J10092 | OTHER | | BLUE SHIELD-INDEMNITY |
| 5 | 35093 | OTHER | | DAVIS VISION (UNICARE) |
| 6 | 718195 | OTHER | | TUFTS |
| 7 | J10092 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 8 | E56942 | OTHER | | FIRST SENIORITY |
| 9 | 150709 | OTHER | | HARVARD/PILGRIM |
| 10 | J10092 | OTHER | | BS-BLUE CARE ELECT |
| 11 | 27385 | OTHER | | CHILDREN'S MEDICAL SECURI |
| 12 | 718195 | OTHER | | TUFTS COMMONWEALTH PPO |
| 13 | 0063847 | OTHER | | HEALTHSOURCE MA |
| 14 | 150709 | OTHER | | HARVARD PILGRIM POS |
| 15 | J10092 | OTHER | | BS-BLUE CARE 66 |
| 16 | E56942 | MEDICARE UPIN | | |
| 17 | 0016752 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 18 | J10092 | OTHER | | HMO BLUE/BLUE CHOICE |
| 19 | 180034282 | OTHER | | RAILROAD MEDICARE |
| 20 | 3067599 | OTHER | | MASS HEALTH (DIV OF MED S |
