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 | 2085R0001X | Radiology | Radiation Oncology | 79255 | MASSACHUSETTS | No |
| 2 | 2085R0001X | Radiology | Radiation Oncology | ME125691 | FLORIDA | No |
| 3 | 2085R0001X | Radiology | Radiation Oncology | MD11456 | 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 | 30348 | OTHER | RHODE ISLAND | NEIGHBR. HLTH PL. PROV. # |
| 2 | 3133087 | MEDICAID | MASSACHUSETTS | |
| 3 | 98985603 | OTHER | MASSACHUSETTS | NETWORK HEALTH |
| 4 | P994555 | OTHER | FLORIDA | FREEDOM |
| 5 | 1493289 | OTHER | RHODE ISLAND | CIGNA PROVIDER NUMBER |
| 6 | 387766 | OTHER | FLORIDA | AVMED |
| 7 | 822225 | OTHER | RHODE ISLAND | USA MNGD. CR. PROV. # |
| 8 | AA15549 | OTHER | RHODE ISLAND | HARV. PILG. PROVIDER # |
| 9 | 015965200 | MEDICAID | FLORIDA | |
| 10 | ZS4X3 | OTHER | FLORIDA | BCBS |
| 11 | 079255 | OTHER | RHODE ISLAND | TUFTS HLTH PLN. PROV. # |
| 12 | 3701804 | OTHER | RHODE ISLAND | AETNA PROVIDER NUMBER |
| 13 | 42700 | OTHER | RHODE ISLAND | HEALTH NEW ENGLAND |
| 14 | 5524206 | OTHER | FLORIDA | AETNA |
| 15 | P00693330 | OTHER | RHODE ISLAND | RAIL ROAD MEDICARE |
| 16 | 1493289 | OTHER | FLORIDA | CIGNA |
| 17 | 7057190 | MEDICAID | RHODE ISLAND | |
| 18 | P01580612 | OTHER | FLORIDA | RR MEDICARE |
| 19 | P01798845 | OTHER | FLORIDA | CLEAR HEALTH ALLIANCE |
| 20 | 008002447 | MEDICAID | CONNECTICUT | |
| 21 | 010011456RI01 | OTHER | CONNECTICUT | ANTHEM BCBS CT PROV. # |
| 22 | 29025-8 | OTHER | RHODE ISLAND | BCBS OF RI PROVIDER # |
| 23 | 3133087 | OTHER | MASSACHUSETTS | MASS HEALTH PROVIDER # |
| 24 | P00762754 | OTHER | MASSACHUSETTS | RAILROAD MEDICARE - CMCCC |
| 25 | 5524206 | OTHER | RHODE ISLAND | AETNA REF/CERT # |
| 26 | P00762779 | OTHER | RHODE ISLAND | RAILROAD MEDICARE - RADIOSURGERY CENTER OF RI |
| 27 | P01107077 | OTHER | MASSACHUSETTS | RAILROAD MCR |
| 28 | 412134 | OTHER | RHODE ISLAND | BCBS RI - BLUECHIP PROV # |
| 29 | J30652 | OTHER | MASSACHUSETTS | BCBS OF MASS PROVIDER # |
| 30 | P971651 | OTHER | FLORIDA | OPTIMUM |
