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 | | 157064 | 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 | 33366 | OTHER | | HEALTHY START |
| 2 | 3356112 | OTHER | | CIGNA HEALTH PLAN |
| 3 | 042472266 | OTHER | | THREE RIVERS |
| 4 | 3185290 | OTHER | | WELFARE |
| 5 | 3185290 | MEDICAID | MASSACHUSETTS | |
| 6 | 784155 | OTHER | | MVP HEALTH CARE |
| 7 | 33366 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 8 | J19477 | OTHER | | BLUE SHIELD INDEMNITY |
| 9 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 10 | 33721 | OTHER | | FALLON COMMUNITY HEALTH |
| 11 | J19477 | OTHER | | BLUE CARE ELECT |
| 12 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 13 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 14 | 2039833 | OTHER | | FIRST HEALTH |
| 15 | 5978731 | OTHER | | AETNA US HEALTHCARE |
| 16 | AA1175 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 17 | J19477 | OTHER | | BLUE SHIELD HMO BLUE |
