Healthcare Provider Details

I. General information

NPI: 1689061392
Provider Name (Legal Business Name): UZOMA IHEAGWARA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MEMORIAL DR
FARRELL PA
16121-1357
US

IV. Provider business mailing address

2200 MEMORIAL DR
FARRELL PA
16121-1357
US

V. Phone/Fax

Practice location:
  • Phone: 724-938-7570
  • Fax:
Mailing address:
  • Phone: 724-938-7570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD470772
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: