Provider Demographics
NPI:1083471411
Name:USIFO, JOANNA CHIOMA (MD,MBBSMSABAIM,MACR)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:CHIOMA
Last Name:USIFO
Suffix:
Gender:F
Credentials:MD,MBBSMSABAIM,MACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 WATERFORD ST
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-5517
Mailing Address - Country:US
Mailing Address - Phone:267-213-2705
Mailing Address - Fax:
Practice Address - Street 1:419 WATERFORD ST
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-5517
Practice Address - Country:US
Practice Address - Phone:267-213-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X, 261QR1300X, 261QP0905X, 261QR1300X
FL47046208D00000X
TN709732085R0204X
PAAA00052310182083C0008X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical InformaticsGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
307218024OtherFSMB
10929560OtherECFMG-EICS
C-UJ214271OtherEPIC ID
PA34607785OtherID NUMBER
72889OtherMDCN -LICENSE CERTIFICATE OF GOOD STANDING