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 | | DPM 264 | 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 | 000264 | OTHER | RHODE ISLAND | TUFTS PROVIDER NO. |
| 2 | 2700390 | OTHER | RHODE ISLAND | UNITED HEALTH CARE PROVID |
| 3 | 202646 | OTHER | RHODE ISLAND | BLUE CHIP PROVIDER NUMBER |
| 4 | 9007056 | MEDICAID | RHODE ISLAND | |
| 5 | 0522002 | OTHER | IDAHO | AETNA PROVIDER NO. |
| 6 | 489022385 | MEDICARE ID-TYPE UNSPECIFIED | RHODE ISLAND | PROVIDER NUMBER |
| 7 | 1097 | OTHER | RHODE ISLAND | NEIGHBORHOOD HEALTH PROVI |
| 8 | 29705-1 | OTHER | RHODE ISLAND | BLUE CROSS BLUE SHIELD |
| 9 | 480033070 | OTHER | RHODE ISLAND | RR MEDICARE PROV. NO. |
| 10 | 0026278001 | OTHER | RHODE ISLAND | CIGNA PROVIDER NUMBER |
| 11 | U19237 | MEDICARE UPIN | RHODE ISLAND | |
