Provider Demographics
NPI:1144434374
Name:IGBOELI, IFEOMA
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:
Last Name:IGBOELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 COVE CIR E
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9578
Mailing Address - Country:US
Mailing Address - Phone:216-926-8335
Mailing Address - Fax:
Practice Address - Street 1:2708 COVE CIR E
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14710-9578
Practice Address - Country:US
Practice Address - Phone:216-926-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253048208600000X, 208600000X
NC2011-01396208600000X
OH35.098122208600000X
PAMD440637208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery