Provider Demographics
NPI:1487885190
Name:ESEMUEDE, IYARE OSAYI (MD)
Entity type:Individual
Prefix:
First Name:IYARE
Middle Name:OSAYI
Last Name:ESEMUEDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-753-0877
Mailing Address - Fax:203-759-1537
Practice Address - Street 1:133 SCOVILL ST STE 303
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-753-0877
Practice Address - Fax:203-759-1533
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT54223208600000X
NY264901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery