Healthcare Provider Details

I. General information

NPI: 1770898363
Provider Name (Legal Business Name): IFEYINWA OKOCHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FY-FY OKOCHA M.D.

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GREENWAY CENTER DR 245
GREENBELT MD
20770-3509
US

IV. Provider business mailing address

7525 GREENWAY CENTER DR 245
GREENBELT MD
20770-3509
US

V. Phone/Fax

Practice location:
  • Phone: 301-474-8118
  • Fax: 301-345-1271
Mailing address:
  • Phone: 301-474-8118
  • Fax: 301-345-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD038794
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0071021
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD038794
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: