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 | 207YX0007X | Otolaryngology | Plastic Surgery within the Head & Neck | 962 | MAINE | 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 | 2427080 | OTHER | MAINE | AETNA |
| 2 | M2672 | OTHER | NEW HAMPSHIRE | NEWHAMPSHIRE CIGNA |
| 3 | 040924 | OTHER | MAINE | ANTHEM BLUE SHIELD |
| 4 | CH8191 | OTHER | MAINE | RAILROAD MCARE GROUP # |
| 5 | MM0108 | MEDICARE ID-TYPE UNSPECIFIED | MAINE | GROUP PROV NUMBER |
| 6 | 2727288 | OTHER | MAINE | CIGNA INDIV PROV # |
| 7 | 015055 | MEDICARE ID-TYPE UNSPECIFIED | MAINE | INDIV PROV # |
| 8 | 002296 | OTHER | MAINE | ANTHEM BLUE SHIELD |
| 9 | D93074 | MEDICARE UPIN | MAINE | |
