Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Ejiro Vivian Agboro-Idahosa, MD

Individual provider Psychiatry Physician · NPI 1104089390

Dr. Ejiro Vivian Agboro-Idahosa, MD is a Psychiatry in Elmira, New York. Qualified in 1994, 32 years ago. Practices with Waverly Medical Associates LLC, a 2-clinician group and accepts Medicare assignment. Licensed in Iowa and New York.

Years since qualifying
32
Licensed in
IA, NY
In the registry since
2008
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

555 Saint Josephs Blvd
Elmira, NY 14901-3223
Phone: (607) 737-7002
Fax: (607) 737-1529
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Child & Adolescent Psychiatry Physician (primary) Taxonomy 2084P0804X · Licence 38473 (IA)
Psychiatry Physician Taxonomy 2084P0800X · Licence 38473 (IA)
Psychiatry Physician Taxonomy 2084P0800X · Licence 275859 (NY)

Record details

NPI number1104089390
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 8, 2008
Last updated in NPPESJune 8, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolOTHER
Graduated 1994 (32 years in practice)
Group practice Waverly Medical Associates Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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