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 | 207V00000X | Obstetrics & Gynecology | | M7441 | TEXAS | No |
| 2 | 207V00000X | Obstetrics & Gynecology | | 25MB11162200 | NEW JERSEY | Yes |
| 3 | 207V00000X | Obstetrics & Gynecology | | 212757 | MASSACHUSETTS | No |
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 | | THREE RIVERS |
| 2 | 160054172 | OTHER | | RAILROAD MEDICARE |
| 3 | 188580801 | MEDICAID | TEXAS | |
| 4 | 409328 | OTHER | | TUFTS HEALTH PLAN |
| 5 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 6 | 2015776 | OTHER | | FIRST HEALTH |
| 7 | 7899252 | OTHER | | AETNA US HEALTHCARE |
| 8 | J24199 | OTHER | | BLUE CARE ELECT |
| 9 | J24199 | OTHER | | BLUE SHIELD HMO BLUE |
| 10 | 0154911 | MEDICAID | MASSACHUSETTS | |
| 11 | 38146 | OTHER | | HEALTHY START |
| 12 | 63348 | OTHER | | FALLON COMM HEALTH PLAN |
| 13 | AA6081 | OTHER | | HARVARD PILGRIM |
| 14 | 188580802 | MEDICAID | TEXAS | |
| 15 | 784223 | OTHER | | MVP HEALTH CARE |
| 16 | 0700407 | OTHER | | EVERCARE |
| 17 | 042472266 | OTHER | | UNITED HEALTHCARE |
| 18 | J24199 | OTHER | | BLUE SHIELD INDEMNITY |
| 19 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 20 | 7012123 | OTHER | | CIGNA HEALTH PLAN |
| 21 | 808113 | MEDICAID | NEW JERSEY | |
