Provider Demographics
NPI:1104086107
Name:IMAHIYEROBO, JOYCE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:IMAHIYEROBO
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 1:143 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1683
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1683
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254815207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104086107OtherNEIGHBORHOOD HEALTH PLAN
042297845OtherUNITED HEALTH CARE
5792931OtherAETNA
AA330484OtherHARVARD PILGRIM
1104086107OtherTUFTS AND TMP
5860263OtherCIGNA
MAJ52294OtherBCBSMA
042297845OtherMULTI-PLAN/PHCS
042297845OtherTRICARE
042297845OtherUNICARE
1104086107OtherFALLON
9237950OtherNETWORK HEALTH