Basic Information
| Provider Information | |||||||||
| NPI: | 1891206579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IORA HEALTH MASSACHUSETTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 TREMONT ST FL 6 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021085004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178045981 | ||||||||
| FaxNumber: | 6177017740 | ||||||||
| Practice Location | |||||||||
| Address1: | 912 RIVER ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | HYDE PARK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021363715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174522303 | ||||||||
| FaxNumber: | 6173294726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2017 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | FERNANDOPULLE | ||||||||
| AuthorizedOfficialFirstName: | RUSHIKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6174544672 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.