National Provider Identifier
Victor Omamode Idahosa, MD
Victor Omamode Idahosa, MD is listed in the NPPES registry with a primary specialty of Addiction Medicine (Internal Medicine) Physician in Waverly, NY and a listed phone number of (607) 821-2444.
Profile Overview
- NPI
- 1528226677
- Provider Type
- Individual
- Primary Specialty
- Addiction Medicine (Internal Medicine) Physician
- Enumeration Date
- May 27, 2008
- Last Updated
- May 10, 2022
Practice Location
- 348 Broad St
- Waverly, NY 14892-1441
Phone: (607) 821-2444
Specialties
- Addiction Medicine (Internal Medicine) Physician (207RA0401X)
Full Record
- NPI
- 1528226677
- Entity Type
- Individual
- Last Name
- Idahosa
- First Name
- Victor
- Middle Name
- Omamode
- Credential
- MD
- 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) 821-2444
- 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
- May 27, 2008
- Last Updated
- May 10, 2022
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- May 10, 2022
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Addiction Medicine (Internal Medicine) Physician (207RA0401X)