Provider Demographics
NPI:1083471411
Name:USIFO, JOANNA CHIOMA (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:CHIOMA
Last Name:USIFO
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 THOROUGHBRED LOOP
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-6628
Mailing Address - Country:US
Mailing Address - Phone:267-213-2705
Mailing Address - Fax:
Practice Address - Street 1:7259 S BINGHAM JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-4860
Practice Address - Country:US
Practice Address - Phone:801-930-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70973208D00000X, 2085R0202X
261QM1300X, 261QR1300X
PAAA00052310182083C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
72889OtherMDCN -LICENSE CERTIFICATE OF GOOD STANDING
C-UJ214271OtherEPIC ID
10929560OtherECFMG-EICS