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 | | 76883 | 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 | 1240284 | OTHER | | UNITED HEALTHCARE PPO |
| 2 | 61747 | OTHER | | HARVARD PILGRIM PPO |
| 3 | 760098 | OTHER | | TUFTS BENEFIT ADMIN |
| 4 | 9324258 | OTHER | | CIGNA HEALTH CARE |
| 5 | 0016061 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 6 | 3102939 | OTHER | | MASS HEALTH/DIV OF MED SV |
| 7 | 61747 | OTHER | | HARVARD PILGRIM POS |
| 8 | 61747 | OTHER | | HARVARD PILGRIM |
| 9 | 760098 | OTHER | | TUFTS |
| 10 | 760098 | OTHER | | TUFTS COMMONWEALTH |
| 11 | 760098 | OTHER | | TUFTS TOTAL HEALTH PLAN |
| 12 | 9324256 | OTHER | | HEALTHSOURCE MASSACHUSETT |
| 13 | 27548 | OTHER | | CHILDREN'S MEDICAL SECURI |
| 14 | E30036 | OTHER | | FIRST SENIORITY |
| 15 | J13255 | OTHER | | BLUE SHIELD-INDEMNITY |
| 16 | J13255 | OTHER | | BS-BLUE CARE ELECT |
| 17 | J13255 | OTHER | | HMO BLUE CHOICE |
