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 | | 153280 | 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 | G11682 | OTHER | | FIRST SENIORITY |
| 2 | G11682 | OTHER | | HARVARD PILGRIM POS |
| 3 | 153280 | OTHER | | TUFTS TOTAL HEALTH PLAN |
| 4 | 27394 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 5 | 3174531 | OTHER | | MASS HEALTH (DIV OF MEDSV |
| 6 | J18335 | OTHER | | BS-BLUECARE ELECT |
| 7 | G11682 | MEDICARE UPIN | | |
| 8 | 0011199 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 9 | 153280 | OTHER | | TUFTS BENEFIT ADMINISTRAT |
| 10 | G11682 | OTHER | | HARVARD PILGRIM |
| 11 | J18335 | OTHER | | BLUE SHIELD INDEMNITY |
| 12 | J18335 | OTHER | | HMO BLUE/BLUE CHOICE |
| 13 | A22447 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 14 | 12-01710 | OTHER | | UNITED HEALTHCARE PPO |
| 15 | 153280 | OTHER | | TUFTS COMMONWEALTH PPO |
| 16 | G11682 | OTHER | | HARVARD PILGRIM PPO |
| 17 | 7999027 | OTHER | | HEALTHSOURCE MASSACHUSETT |
| 18 | 153280 | OTHER | | TUFTS |
| 19 | 7999027 | OTHER | | CIGNA HEALTH CARE |
