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 | 207XX0005X | Orthopaedic Surgery | Sports Medicine | MD09787 | RHODE ISLAND | 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 | 050397249 | OTHER | | WORKERS COMPENSTION |
| 2 | 209002723 | MEDICARE PIN | RHODE ISLAND | |
| 3 | R000315 | OTHER | | TRICARE |
| 4 | 050397249 | OTHER | | MULTIPLANS |
| 5 | 050397249 | OTHER | | FIRST HLTH/COVENTRY/HCVM |
| 6 | CD1829 | OTHER | | RAILROAD MEDICARE |
| 7 | 23922 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH PLANS |
| 8 | G61015 | MEDICARE UPIN | RHODE ISLAND | |
| 9 | 402836 | OTHER | RHODE ISLAND | BLUECHIP OF RI |
| 10 | 9002723 | MEDICAID | RHODE ISLAND | |
| 11 | 2723 | OTHER | RHODE ISLAND | BC BS OF RI |
| 12 | 050397249 | OTHER | | UNITEDHEALTHCARE |
| 13 | 050397249 | OTHER | | PEQUOT PLUS HEALTH PLANS |
| 14 | 103714900 | OTHER | | U.S. DEPT. OF LABOR-WC |
| 15 | 778764 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLANS |
| 16 | 0860497-002 | OTHER | | CIGNA |
| 17 | 7278316 | OTHER | | AETNA |
| 18 | 0771230001 | MEDICARE NSC | | |
| 19 | AA48450 | OTHER | MASSACHUSETTS | HARVARD PILGRIM HEALTH |
