Healthcare Provider Details

I. General information

NPI: 1023571171
Provider Name (Legal Business Name): OSEOGIE OKOJIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 07/04/2020
Certification Date: 07/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

24 FANEUIL ST
BRIGHTON MA
02135-1940
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2777
  • Fax:
Mailing address:
  • Phone: 410-926-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAU9053125-O03
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number285346
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: