Healthcare Provider Details

I. General information

NPI: 1356484083
Provider Name (Legal Business Name): CHETANNA I OKASI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 COLUMBIA 100 PKWY STE E
COLUMBIA MD
21045-2336
US

IV. Provider business mailing address

8900 COLUMBIA 100 PKWY STE E
COLUMBIA MD
21045-2336
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-7722
  • Fax: 410-730-7725
Mailing address:
  • Phone: 410-730-7722
  • Fax: 410-730-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0070939
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: