Provider Demographics
NPI:1093780264
Name:OKWIYA, ISAYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAYA
Middle Name:A
Last Name:OKWIYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:301 RANDOLPH STREET
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-479-4306
Mailing Address - Fax:410-479-1714
Practice Address - Street 1:302 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21643
Practice Address - Country:US
Practice Address - Phone:410-943-8763
Practice Address - Fax:410-943-8244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD63649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46613Medicare UPIN