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 | 2085R0202X | Radiology | Diagnostic Radiology | 18098 | NEW HAMPSHIRE | Yes |
| 2 | 2085R0202X | Radiology | Diagnostic Radiology | 74528 | MASSACHUSETTS | No |
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 | | PRIVATE HEALTHCARE SYSTEM |
| 2 | M02254 | OTHER | | BLUE SHIELD HMO BLUE |
| 3 | 44839 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 4 | 7613577 | OTHER | | AETNA US HEALTHCARE |
| 5 | M02254 | OTHER | | BLUE CARE ELECT |
| 6 | 042472266 | OTHER | | THREE RIVERS |
| 7 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 8 | 7794897 | OTHER | | CIGNA HEALTH PLAN |
| 9 | P00005834 | OTHER | | RAILROAD MEDICARE |
| 10 | 2090677 | OTHER | | FIRST HEALTH |
| 11 | 44839 | OTHER | | HEALTHY START |
| 12 | 470523 | OTHER | | TUFTS HEALTH PLAN |
| 13 | G34293 | MEDICARE UPIN | | |
| 14 | 2002451 | MEDICAID | MASSACHUSETTS | |
| 15 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 16 | 57116 | OTHER | | FALLON COMMUNITY HEALTH P |
| 17 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 18 | 784211 | OTHER | | MVP HEALTH CARE |
| 19 | AA5959 | OTHER | | HARVARD PILGRIM |
