Individual
VICTOR OMAMODE IDAHOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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) 821-2444
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
276514
NY
Other
Enumeration date
05/27/2008
Last updated
05/10/2022
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