=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669270989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIRA HEALTH IL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2025
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UNIT 401, 22 HIGHBURY GROVE
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | UNITED KINGDOM
-----------------------------------------------------
Zip | N52EF
-----------------------------------------------------
Country | GB
-----------------------------------------------------
Telephone | 866-856-2140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1257 WORCESTER RD # 1046
-----------------------------------------------------
City | FRAMINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01701-5217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-856-2140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ABRAHAM N MORSE
-----------------------------------------------------
Credential | MD MBA
-----------------------------------------------------
Telephone | 508-243-7396
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------