Healthcare Provider Details

I. General information

NPI: 1538721303
Provider Name (Legal Business Name): OSARODION OSA IGBINOMWANHIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 MAPLE ST STE 1
HOLYOKE MA
01040-5140
US

IV. Provider business mailing address

230 MAPLE ST STE 1
HOLYOKE MA
01040-5140
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2200
  • Fax: 413-539-9472
Mailing address:
  • Phone: 413-420-2200
  • Fax: 413-539-9472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number291615
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: