Provider Demographics
NPI:1457513756
Name:ONAMADE, IROSO (MD)
Entity Type:Individual
Prefix:
First Name:IROSO
Middle Name:
Last Name:ONAMADE
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 1:41 KRISTINE LN
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-8817
Mailing Address - Country:US
Mailing Address - Phone:217-637-5051
Mailing Address - Fax:
Practice Address - Street 1:70 EAST ST
Practice Address - Street 2:DEPT ANESTHESIOLOGY
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-4597
Practice Address - Country:US
Practice Address - Phone:617-638-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-237689390200000X
CA256640207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program