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 | 207V00000X | Obstetrics & Gynecology | | 204555 | MASSACHUSETTS | No |
2 | 207V00000X | Obstetrics & Gynecology | | 29701 | SOUTH CAROLINA | No |
3 | 207VG0400X | Obstetrics & Gynecology | Gynecology | 29701 | SOUTH CAROLINA | 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 | | PRIVATE HEALTHCARE SYSTEM |
2 | J22633 | OTHER | | BLUE SHIELD INDEMNITY |
3 | AA3715 | OTHER | | HARVARD PILGRIM HEALTH CA |
4 | 0120961 | MEDICAID | MASSACHUSETTS | |
5 | 0120961 | OTHER | | MEDICAID WELFARE |
6 | 042472266 | OTHER | | TRICARE CHAMPUS |
7 | 0700410 | OTHER | | EVERCARE |
8 | 1009200 | OTHER | | CIGNA HEALTH PLAN |
9 | A31235 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
10 | J22633 | OTHER | | BLUE CARE ELECT |
11 | 7099315 | OTHER | | AETNA US HEALTHCARE |
12 | 37554 | OTHER | | HEALTHY START |
13 | 784225 | OTHER | | MVP HEALTH CARE |
14 | A31235 | OTHER | | MEDICARE B |
15 | J22633 | OTHER | | BLUE SHIELD HMO BLUE |
16 | 042472266 | OTHER | | ONE HEALTH PLAN |
17 | 042472266 | OTHER | | THREE RIVERS |
18 | 160049837 | OTHER | | RAILROAD MEDICARE |
19 | 45822 | OTHER | | FALLON COMMUNITY HEALTH P |
20 | H19207 | MEDICARE UPIN | | |