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General NPI Number Information
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NPI Number | 1700566635
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Entity Type | Organization
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Legal Business Name | INNER HEALING MEDICAL PLLC
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 465 WAVERLEY OAKS RD STE 201
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City | WALTHAM
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State | MA
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Zip | 02452-8489
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Country | US
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Telephone | 781-614-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 33 MOON HILL RD
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City | LEXINGTON
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State | MA
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Zip | 02421-6112
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Country | US
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Telephone | 781-614-7800
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS AND MEMBER SERVICE
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Name | SARA RAIMUNDO
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Credential |
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Telephone | 781-614-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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