Provider Demographics
NPI:1861020315
Name:IHEAGWARA, CHARITY (MD)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:IHEAGWARA
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-808-8889
Mailing Address - Fax:570-808-4050
Practice Address - Street 1:950 E MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0028
Practice Address - Country:US
Practice Address - Phone:570-808-8889
Practice Address - Fax:570-808-4050
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD489082207RI0200X
NJ530083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease