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 | 208800000X | Urology | | 54840 | 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 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 2 | 29185 | OTHER | | CHILDRENS MEDICAL SEC |
| 3 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 5169476 | OTHER | | CIGNA HEALTH PLAN |
| 5 | 9900197 | OTHER | | FALLON COMM HEALTH PLAN |
| 6 | 3100316 | MEDICAID | MASSACHUSETTS | |
| 7 | 042472266 | OTHER | | HEALTHCARE VALUE MNGMT |
| 8 | 1900126 | OTHER | | EVERCARE |
| 9 | AA6078 | OTHER | | HARVARD PILGRIM HLTH CARE |
| 10 | J12368 | OTHER | | MEDICARE B |
| 11 | 784031 | OTHER | | MVP HEALTH CARE |
| 12 | F24947 | MEDICARE UPIN | | |
| 13 | J12368 | OTHER | | BLUE CARE ELECT |
| 14 | J12368 | OTHER | | BLUE SHIELD INDEMNITY |
| 15 | J12368 | OTHER | | BLUE SHIELD HMO BLUE |
| 16 | 1060773 | OTHER | | FIRST HEALTH |
| 17 | 29185 | OTHER | | HEALTHY START |
| 18 | 3100316 | OTHER | | MEDICAID WELFARE |
| 19 | 7869344 | OTHER | | AETNA US HEALTHCARE |
| 20 | J12368 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 21 | Z150766 | MEDICARE PIN | ARIZONA | |
