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 | 207RC0000X | Internal Medicine | Cardiovascular Disease | 030739 | CONNECTICUT | No |
| 2 | 207UN0901X | Nuclear Medicine | Nuclear Cardiology | 030739 | CONNECTICUT | No |
| 3 | 207RI0011X | Internal Medicine | Interventional Cardiology | 030739 | CONNECTICUT | 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 | 0R0351 | OTHER | CONNECTICUT | HEALTH NET OF NORTHEAST |
| 2 | D400039795 | MEDICARE PIN | CONNECTICUT | |
| 3 | 110036141 | OTHER | CONNECTICUT | RAILROAD MEDICARE |
| 4 | 010030739CT01 | OTHER | CONNECTICUT | ANTHEM BC & BS |
| 5 | 1346278512 | MEDICAID | CONNECTICUT | |
| 6 | 060000774 | MEDICARE PIN | CONNECTICUT | |
| 7 | 4127784 | OTHER | CONNECTICUT | AETNA HEALTH LANS |
| 8 | B85396 | MEDICARE UPIN | CONNECTICUT | |
| 9 | 010130739 | OTHER | CONNECTICUT | CIGNA HEALTH PLANS |
| 10 | 030739 | OTHER | CONNECTICUT | CONNECTICARE |
| 11 | 001307398 | MEDICAID | CONNECTICUT | |
| 12 | P381955 | OTHER | CONNECTICUT | OXFORD HEALTH PLANS |
