Individual
ELIAS NAME
Active
Individual
ELIAS NAME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
212968
MA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
212968
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0032451
MEIGHBORHOOD HEALTH PLAN
MA
01
—
28194
BOSTON HEALTH NET
MA
01
—
971811
NETWORK HEALTH
MA
01
—
NAJ27356
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/26/2006
Last updated
11/12/2025
Update your record
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