| Waverly Medical Associates Llc | |
|
348 Broad St Waverly NY 14892-1441 | |
| (607) 821-2444 | |
| (607) 948-1030 |
| Full Name | Waverly Medical Associates Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 348 Broad St, Waverly, New York |
| Authorized Official Name and Position | Victor Omamode Idahosa (OWNER) |
| Authorized Official Contact | 6078212444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waverly Medical Associates Llc 348 Broad St Waverly NY 14892-1441 Ph: (607) 821-2444 | Waverly Medical Associates Llc 348 Broad St Waverly NY 14892-1441 Ph: (607) 821-2444 |
| NPI Number | 1457757486 |
|---|---|
| Provider Enumeration Date | 11/19/2014 |
| Last Update Date | 09/23/2016 |
| Medicare PECOS PAC ID | 0547589541 |
|---|---|
| Medicare Enrollment ID | O20150424000126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457757486 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 276514 (New York) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 275859 (New York) | Secondary |
| Provider Name | Victor O Idahosa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528226677 PECOS PAC ID: 1153484365 Enrollment ID: I20150424000173 |
| Provider Name | Ejiro V Agboro Idahosa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104089390 PECOS PAC ID: 1355495649 Enrollment ID: I20150617001896 |
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