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.

NPI 1457757486Waverly, NYInternal Medicine Physician

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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Organization Overview

Waverly Medical Associates LLC is a healthcare organization in Waverly, New York, in Tioga County. The New York State Department of Health’s Wadsworth Center lists it as a registered limited-service laboratory directed by Victor O. Idahosa, M.D., with provider-performed microscopy certification. The state listing identifies specific on-site testing capabilities including glucose, pregnancy urine testing, Strep A testing, urinalysis, occult blood, KOH preps, direct wet mounts, and urine sediment exams.

Full Record
NPI
1457757486
Entity Type
Organization
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
Taxonomies
Internal Medicine Physician (207R00000X), Psychiatry Physician (2084P0800X)