Healthcare Provider Details

I. General information

NPI: 1952393209
Provider Name (Legal Business Name): MARK S OKONSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 ABIGAIL LN
PORT MATILDA PA
16870-7153
US

IV. Provider business mailing address

13440 BLUE BAY CIR
FORT MYERS FL
33913-8761
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-5011
  • Fax: 814-272-6531
Mailing address:
  • Phone: 239-209-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD488012
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number71344
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: