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 | 207R00000X | Internal Medicine | | 44903 | 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 | E47011 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 3 | 5020732 | OTHER | | CIGNA HEALTH PLAN |
| 4 | E47011 | OTHER | | BLUE SHIELD INDEMNITY |
| 5 | E47011 | OTHER | | BLUE SHIELD HMO BLUE |
| 6 | E47011 | OTHER | | MEDICARE B |
| 7 | 26851 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 8 | 0141038 | OTHER | | MEDICAID WELFARE |
| 9 | 043058466 | OTHER | | HEALTHCARE VALUE MANAGMEN |
| 10 | 26851 | OTHER | | HEALTHY START |
| 11 | 9900035 | OTHER | | FALLON COMMUNITY HEALTH P |
| 12 | E47011 | OTHER | | BLUE CARE ELECT |
| 13 | 0141038 | MEDICAID | MASSACHUSETTS | |
| 14 | 784246 | OTHER | | MVP HEALTH CARE |
| 15 | AA1193 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 16 | A55123 | MEDICARE UPIN | | |
| 17 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 18 | 042472266 | OTHER | | THREE RIVERS |
| 19 | 4034909 | OTHER | | AETNA US HEALTHCARE |
| 20 | 934922 | OTHER | | FIRST HEALTH |
