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 | 213ES0131X | Podiatrist | Foot Surgery | DPM00302 | 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 | 0000021254 | OTHER | | GENERIC4 |
| 2 | 11092609 | OTHER | RHODE ISLAND | CAQH# |
| 3 | AA69503 | OTHER | RHODE ISLAND | HARVARD PILGRIM |
| 4 | 4024 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH RI |
| 5 | 407225 | OTHER | | BLUE CHIP GROUP # |
| 6 | 204928511 | OTHER | PUERTO RICO | UNITED HEALTH CARE |
| 7 | 432037955 | OTHER | | MED EX GROUP # |
| 8 | 5095486002 | OTHER | | CIGNA |
| 9 | AETNA COM 7342159 | OTHER | RHODE ISLAND | AETNA HMO 1359024 |
| 10 | ZDZ388 | OTHER | | MED EX |
| 11 | 0000031650 | OTHER | RHODE ISLAND | BCBS |
| 12 | SSN#-TAX ID# 2049285 | OTHER | RHODE ISLAND | RAILROAD MEDICARE |
| 13 | PT SSN# | OTHER | RHODE ISLAND | TRI CARE |
| 14 | 2382382 | OTHER | | GENERIC3 |
| 15 | 480034977 | OTHER | | GENERIC7 |
| 16 | 7009003 | MEDICAID | RHODE ISLAND | |
| 17 | 407225 | OTHER | RHODE ISLAND | BLUE CHIP |
| 18 | 3916940001 | OTHER | | GENERIC6 |
