National Provider Identifier
Waverly Medical Associates LLC
Waverly Medical Associates LLC is listed in the NPPES registry with a primary specialty of Internal Medicine Physician in Waverly, NY and a listed phone number of (607) 821-2444.
Source: public NPPES record, last updated September 23, 2016. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1457757486
- Provider Type
- Organization
- Primary Specialty
- Internal Medicine Physician
- Enumeration Date
- November 19, 2014
- Last Updated
- September 23, 2016
Practice Location
- 348 Broad St
- Waverly, NY 14892-1441
Phone: (607) 821-2444
Authorized Official
- Name
- Dr. Victor Omamode Idahosa
- Title
- Owner
- Credentials
- M.D.
- Phone
- (607) 821-2444
Specialties
- Internal Medicine Physician (207R00000X)
- Psychiatry Physician (2084P0800X)
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Full Record
- NPI
- 1457757486
- Entity Type
- Organization
- EIN
- <UNAVAIL>
- Organization Name
- Waverly Medical Associates LLC
- Mailing Street Address
- 348 Broad St
- Mailing City
- Waverly
- Mailing State
- NY
- Mailing ZIP Code
- 14892-1441
- Mailing Country
- US
- Mailing Phone
- (607) 821-2444
- Mailing Fax
- (607) 948-1030
- Practice Street Address
- 348 Broad St
- Practice City
- Waverly
- Practice State
- NY
- Practice ZIP Code
- 14892-1441
- Practice Country
- US
- Practice Phone
- (607) 821-2444
- Practice Fax
- (607) 948-1030
- Enumeration Date
- November 19, 2014
- Last Updated
- September 23, 2016
- Authorized Official Last Name
- Idahosa
- Authorized Official First Name
- Victor
- Authorized Official Middle Name
- Omamode
- Authorized Official Title
- Owner
- Authorized Official Phone
- (607) 821-2444
- Organization Subpart
- No
- Authorized Official Name Prefix Text
- Dr.
- Authorized Official Credential Text
- M.D.
- Taxonomy Group 1
- 193200000X Multi-Specialty Group
- Taxonomy Group 2
- 193200000X Multi-Specialty Group
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Internal Medicine Physician (207R00000X), Psychiatry Physician (2084P0800X)