Provider Demographics
NPI:1437130473
Name:FERNANDOPULLE, RUSHIKA J (MD)
Entity type:Individual
Prefix:DR
First Name:RUSHIKA
Middle Name:J
Last Name:FERNANDOPULLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:BIGELOW TEACHING SERVICE INPATIENT GRB 740
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-6193
Practice Address - Fax:617-724-3166
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-05-13
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Provider Licenses
StateLicense IDTaxonomies
NHEL03407207R00000X
MA213352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20961OtherPERMANENT LICENCE
MA0178110Medicaid
MA791852OtherTUFTS HEALTH PLAN
NHEL03407OtherNH LICENSE
MAJ25302OtherBCBS MA