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 | 207RI0200X | Internal Medicine | Infectious Disease | 53983 | 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 | 678810 | OTHER | | HEALTHSOURCE |
| 2 | 6198066 | MEDICAID | MASSACHUSETTS | |
| 3 | 053983 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN |
| 4 | 30004119 | OTHER | NEW HAMPSHIRE | NH MEDICAID |
| 5 | 92-00140 | OTHER | | EVERCARE |
| 6 | J04378 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 7 | 110214702 | OTHER | | RAILROAD MEDICARE |
| 8 | 0011275 | OTHER | | NEIGHBORHOOD HEALTH PLAN |
| 9 | 1750172 | OTHER | | CIGNA HEALTHCARE |
| 10 | A57670 | OTHER | NEW HAMPSHIRE | ANTHEM BLUE CROSS |
| 11 | J04378 | OTHER | MARYLAND | BLUE CROSS BLUE SHIELD |
| 12 | 110066143A | MEDICAID | MASSACHUSETTS | |
| 13 | 61903 | OTHER | MASSACHUSETTS | HARVARD PILGRIM HEALTHCAR |
| 14 | A57670 | MEDICARE UPIN | MASSACHUSETTS | |
| 15 | 9765855 | OTHER | | NETWORK HEALTH |
| 16 | 1992700934 | OTHER | MASSACHUSETTS | FALLON COMMUNITY HEALTH PLAN |
