Provider Demographics
NPI:1497376289
Name:IGABARI, CHIDERAA N (MD)
Entity Type:Individual
Prefix:
First Name:CHIDERAA
Middle Name:N
Last Name:IGABARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 THOREAU CT APT 6
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3899
Mailing Address - Country:US
Mailing Address - Phone:303-434-5956
Mailing Address - Fax:
Practice Address - Street 1:3780 HECKTOWN RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2355
Practice Address - Country:US
Practice Address - Phone:610-333-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220079207Q00000X
PAMD482134207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine