Healthcare Provider Details

I. General information

NPI: 1871170704
Provider Name (Legal Business Name): ROBERT M OKANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE BLDG 449
GROTON CT
06349-2324
US

IV. Provider business mailing address

BLDG 159 TROUT AVE NAVSUBASE NLON
GROTON CT
06349
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-6485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: