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 | 207R00000X | Internal Medicine | | 58800 | 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 | 0401687 | OTHER | | EVERCARE |
| 2 | 26843 | OTHER | | HEALTHY START |
| 3 | AA1273 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 4 | J07172 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 5 | J07172 | OTHER | | BLUE SHIELD INDEMNITY |
| 6 | 1107579 | OTHER | | CIGNA HEALTH PLAN |
| 7 | 5601458 | OTHER | | AETNA US HEALTHCARE |
| 8 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 9 | 9900817 | OTHER | | FALLON COMMUNITY HLTH PLN |
| 10 | J07172 | OTHER | | BLUE CARE ELECT |
| 11 | 26843 | OTHER | | CHILDRENS MED SEC PLAN |
| 12 | 3031730 | OTHER | | MEDICAID/WELFARE |
| 13 | 3031730 | MEDICAID | MASSACHUSETTS | |
| 14 | J07172 | OTHER | | MEDICARE B |
| 15 | 1150185 | OTHER | | FIRST HEALTH |
| 16 | J07172 | OTHER | | BLUE SHIELD HMO BLUE |
| 17 | A66560 | MEDICARE UPIN | | |
| 18 | 042472266 | OTHER | | HEALTHCARE VALUE MGMT |
| 19 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 20 | 784165 | OTHER | | MVP HEALTH CARE |
