Provider Demographics
NPI:1114307048
Name:OKIGBO, ROSELINE OGOCHUKWU (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSELINE
Middle Name:OGOCHUKWU
Last Name:OKIGBO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:OGONNA
Other - Middle Name:IJEOMA
Other - Last Name:ODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15 VALLEY PARK S
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1328
Mailing Address - Country:US
Mailing Address - Phone:301-717-1349
Mailing Address - Fax:
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016361207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine