Healthcare Provider Details

I. General information

NPI: 1477008860
Provider Name (Legal Business Name): LUCKY OKOJIE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD LAHEY HOSPITAL AND MEDICAL CENTER
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone: 781-744-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10704
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5798
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: