MEDICARE: IKECHI F OKWARA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D43351	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	75859903	OTHER	MD	BLUE SHIELD
4	P00433571	OTHER	MD	RAILROAD MED

General Provider Information

NPI Number	:	1265472567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IKECHI F OKWARA MD

Provider Business Mailing Address
First Line	:	3815 DEEP HOLLOW WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-1275
Country	:	US
Telephone Number	:	301-313-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	12200 ANNAPOLIS RD
Second Line	:	STE 316
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-313-0600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/18/2011

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Directions to “ IKECHI F OKWARA MD” Practice Location

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