Provider Demographics
NPI:1043205503
Name:OKEN, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:OKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 UNION DEPOSIT RD
Mailing Address - Street 2:STE 140
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3774
Mailing Address - Country:US
Mailing Address - Phone:717-652-6605
Mailing Address - Fax:717-652-6431
Practice Address - Street 1:4700 UNION DEPOSIT RD
Practice Address - Street 2:STE 140
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-652-6605
Practice Address - Fax:717-652-6431
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052003L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F78899Medicare UPIN
PA767129GBAMedicare ID - Type Unspecified