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 | 2084N0600X | Psychiatry & Neurology | Clinical Neurophysiology | MD06881 | RHODE ISLAND | No |
| 2 | 2084N0400X | Psychiatry & Neurology | Neurology | MD06881 | RHODE ISLAND | No |
| 3 | 174400000X | Specialist | | MD06881 | 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 | 050513332 | OTHER | RHODE ISLAND | UNITED HEALTHCARE OF NE |
| 2 | 12004647 | OTHER | | AETNA |
| 3 | 130023300 | OTHER | | RAILROAD MEDICARE |
| 4 | AA2920 | OTHER | | PILGRIM |
| 5 | 050513332 | OTHER | | OXFORD |
| 6 | 21339 | OTHER | RHODE ISLAND | BLUE CROSS BLUE SHIELD RI |
| 7 | C90742 | MEDICARE UPIN | RHODE ISLAND | |
| 8 | 687027 | OTHER | | TUFTS |
| 9 | 050430968-003 | OTHER | | CIGNA |
| 10 | 200329 | OTHER | RHODE ISLAND | BLUE CHIP |
| 11 | 007008536 | MEDICARE ID-TYPE UNSPECIFIED | RHODE ISLAND | MEDICARE ID NUMBER |
| 12 | 050513332 | OTHER | | HUMANA |
| 13 | 1122662 | OTHER | RHODE ISLAND | FIRST HEALTH |
| 14 | GL09486 | MEDICAID | RHODE ISLAND | |
| 15 | 1039599000 | OTHER | | USDE |
