MEDICARE: INNER RICHES OSTEOPATHIC MEDICAL ASSOCIATES INC

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	2084H0002X	Hospice and Palliative Medicine (Psychiatry & Neurology) Physician	0102201608	VA
2	2084P0804X	Child & Adolescent Psychiatry Physician	0102201608	VA
3	2084P0800X	Psychiatry Physician	0102201608	VA

General Provider Information

NPI Number	:	1669841839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER RICHES OSTEOPATHIC MEDICAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2814 S ATLANTIC AVE STE C
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-5802
Country	:	US
Telephone Number	:	240-731-6929
Fax Number	:	703-783-0099

Provider Business Practice Location Address
First Line	:	2814 S ATLANTIC AVE STE C
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-5802
Country	:	US
Telephone Number	:	240-731-6929
Fax Number	:	703-783-0099

Authorized Official
Title or Position	:	CORPORATE OWNER
Name	:	DR. HADASSAH ELIORA AARONSON
Credential	:	DO, MPH
Telephone Number	:	240-731-6929

Provider Enumeration Date	:	09/17/2015
Last Update Date	:	11/01/2021

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