Healthcare Provider Details

I. General information

NPI: 1518980812
Provider Name (Legal Business Name): GODSWILL O OKOJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 TOLEDO TER STE 108
HYATTSVILLE MD
20782-8156
US

IV. Provider business mailing address

3331 TOLEDO TER STE 108
HYATTSVILLE MD
20782-8156
US

V. Phone/Fax

Practice location:
  • Phone: 301-408-4111
  • Fax: 301-408-4600
Mailing address:
  • Phone: 301-408-4111
  • Fax: 301-408-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0050545
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: