Healthcare Provider Details

I. General information

NPI: 1104343466
Provider Name (Legal Business Name): MR. HENRY OKOJIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 ANNAPOLIS RD
HYATTSVILLE MD
20784-1310
US

IV. Provider business mailing address

6421 ANNAPOLIS RD
HYATTSVILLE MD
20784-1310
US

V. Phone/Fax

Practice location:
  • Phone: 301-772-1100
  • Fax: 301-747-1604
Mailing address:
  • Phone: 301-772-1100
  • Fax: 301-747-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberO220303000696
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: