Waverly Medical Associates LLC

NPI #1457757486 in Waverly, New York

Provider Information

NPI Number: 1457757486
Entity Type: Organization
Organization Name: Waverly Medical Associates LLC
Primary Specialty: Internal Medicine
Enumeration Date: Nov 19, 2014
Last Updated: Sep 23, 2016

Practice Location

Address: 348 BROAD ST
City: Waverly
State: New York
ZIP Code: 14892-1441
Phone: (607) 821-2444

Authorized Official

Name: DR. VICTOR OMAMODE IDAHOSA, M.D.
Title: OWNER
Phone: (607) 821-2444

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Internal Medicine	207R00000X	Primary

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