Provider Demographics
NPI:1891206579
Name:IORA HEALTH MASSACHUSETTS, P.C.
Entity Type:Organization
Organization Name:IORA HEALTH MASSACHUSETTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUSHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDOPULLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-454-4672
Mailing Address - Street 1:101 TREMONT ST FL 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-5004
Mailing Address - Country:US
Mailing Address - Phone:617-804-5981
Mailing Address - Fax:617-701-7740
Practice Address - Street 1:912 RIVER ST STE 201
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3715
Practice Address - Country:US
Practice Address - Phone:617-452-2303
Practice Address - Fax:617-329-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty