Provider Demographics
NPI:1669841839
Name:INNER RICHES OSTEOPATHIC MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:INNER RICHES OSTEOPATHIC MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HADASSAH
Authorized Official - Middle Name:ELIORA
Authorized Official - Last Name:AARONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:240-731-6929
Mailing Address - Street 1:2814 S ATLANTIC AVE STE C
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32118-5802
Mailing Address - Country:US
Mailing Address - Phone:240-731-6929
Mailing Address - Fax:703-783-0099
Practice Address - Street 1:2814 S ATLANTIC AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118-5802
Practice Address - Country:US
Practice Address - Phone:240-731-6929
Practice Address - Fax:703-783-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022016082084H0002X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF174Medicare PIN
VAF174Medicare PIN