MEDICARE: IORA HEALTH MASSACHUSETTS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548764798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IORA HEALTH MASSACHUSETTS PC

Provider Business Mailing Address
First Line	:	101 TREMONT ST FL 6
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02108-5004
Country	:	US
Telephone Number	:	617-454-4672
Fax Number	:	617-701-7740

Provider Business Practice Location Address
First Line	:	489 BEARSES WAY
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-2707
Country	:	US
Telephone Number	:	508-771-4092
Fax Number	:	508-771-9466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RUSHIKA FERNANDOPULLE
Credential	:	MD
Telephone Number	:	617-454-4672

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	03/22/2018

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