Healthcare Provider Details

I. General information

NPI: 1174083711
Provider Name (Legal Business Name): OKECHUKWU C OKOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 MILL STREET
HAGERSTOWN MD
21740
US

IV. Provider business mailing address

346 MILL ST
HAGERSTOWN MD
21740-6138
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-6680
  • Fax: 301-714-1506
Mailing address:
  • Phone: 301-791-6680
  • Fax: 301-714-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0101142
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: