Provider Demographics
NPI:1700566635
Name:INNER HEALING MEDICAL PLLC
Entity Type:Organization
Organization Name:INNER HEALING MEDICAL PLLC
Other - Org Name:INNER HEALING MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF OPERATIONS AND MEMBER SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIMUNDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-614-7800
Mailing Address - Street 1:33 MOON HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6112
Mailing Address - Country:US
Mailing Address - Phone:781-614-7800
Mailing Address - Fax:
Practice Address - Street 1:465 WAVERLEY OAKS RD STE 201
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8489
Practice Address - Country:US
Practice Address - Phone:781-614-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty