Healthcare Provider Details

I. General information

NPI: 1083471411
Provider Name (Legal Business Name): JOANNA CHIOMA USIFO MD,MBBSMS.ABAIM,MACR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 WATERFORD ST
EDINBORO PA
16412-5517
US

IV. Provider business mailing address

419 WATERFORD ST
EDINBORO PA
16412-5517
US

V. Phone/Fax

Practice location:
  • Phone: 267-213-2705
  • Fax:
Mailing address:
  • Phone: 267-213-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number47046
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number70973
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License NumberAA0005231018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: