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 | 2085R0204X | Radiology | Vascular & Interventional Radiology | 49280 | MASSACHUSETTS | No |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | 49280 | 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 | 6192459 | MEDICAID | MASSACHUSETTS | |
| 2 | 042477296 | OTHER | MASSACHUSETTS | UNITED HEALTH CARE |
| 3 | 244863 | OTHER | MASSACHUSETTS | HARVARD PILGRIM HEALTH PL |
| 4 | 0007041 | OTHER | MASSACHUSETTS | NEIGHBORHOOD HEALTH PLANS |
| 5 | J03575 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD |
| 6 | 988401 | OTHER | MASSACHUSETTS | NETWORK HEALTH |
| 7 | 72318 | OTHER | MASSACHUSETTS | CIGNA |
| 8 | 042477296 | OTHER | MASSACHUSETTS | PRIVATE HEALTH CARE SYSTE |
| 9 | 6192459 | OTHER | MASSACHUSETTS | HEALTHY START |
| 10 | J03575 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 11 | 042477296 | OTHER | MASSACHUSETTS | HEALTH CARE VALUE MANAGEM |
| 12 | 049280 | OTHER | MASSACHUSETTS | TUFTS HEALTH PLAN |
| 13 | 300121242 | OTHER | MASSACHUSETTS | RAILROAD MEDICARE |
| 14 | 61930 | OTHER | MASSACHUSETTS | FALLON COMMUNITY HEALTH P |
| 15 | B76881 | MEDICARE UPIN | MASSACHUSETTS | |
