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Organization
WAVERLY MEDICAL ASSOCIATES LLC
Active
Organization
WAVERLY MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR OMAMODE IDAHOSA M.D. (OWNER)
(607) 821-2444
Entity
Organization
Contact information
Practice address
348 BROAD ST, WAVERLY, NY 14892-1441
(607) 821-2444
(607) 948-1030
Mailing address
348 BROAD ST, WAVERLY, NY 14892-1441
(607) 821-2444
(607) 948-1030
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
276514
NY
2084P0800X
Psychiatry Physician
275859
NY
Other
Enumeration date
11/19/2014
Last updated
09/23/2016
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