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 | 213E00000X | Podiatrist | | | | 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 | 1358102 | OTHER | RHODE ISLAND | AETNA COMMERCIAL |
| 2 | 9004977 | MEDICAID | RHODE ISLAND | |
| 3 | 1358102 | OTHER | RHODE ISLAND | AETNA HMO |
| 4 | ========= | OTHER | RHODE ISLAND | CIGNA |
| 5 | ========= | OTHER | RHODE ISLAND | UNITED HEALTH CARE |
| 6 | 6042760001 | MEDICARE NSC | RHODE ISLAND | |
| 7 | 489004977 | MEDICARE PIN | RHODE ISLAND | |
| 8 | PT SS#-TAX ID#204928 | OTHER | RHODE ISLAND | RAILROAD MEDICARE |
| 9 | ========= | OTHER | RHODE ISLAND | TAX ID # |
| 10 | ========= | OTHER | RHODE ISLAND | BLUE CHIP OF RI |
| 11 | 1909A | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH |
| 12 | ========= | OTHER | RHODE ISLAND | TRI CARE |
| 13 | ========= | OTHER | RHODE ISLAND | BCBS OF RI |
| 14 | ========= | OTHER | RHODE ISLAND | HARVARD PILGRIM |
