Provider Demographics
NPI:1265472567
Name:OKWARA, IKECHI F (MD)
Entity Type:Individual
Prefix:
First Name:IKECHI
Middle Name:F
Last Name:OKWARA
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 1:3815 DEEP HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1275
Mailing Address - Country:US
Mailing Address - Phone:301-313-0600
Mailing Address - Fax:
Practice Address - Street 1:12200 ANNAPOLIS RD
Practice Address - Street 2:STE 316
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9182
Practice Address - Country:US
Practice Address - Phone:301-313-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD130271000Medicaid
MD409972900Medicaid
MD75859903OtherBLUE SHIELD
MDP00433571OtherRAILROAD MED
MDF71230Medicare UPIN
MD130271000Medicaid
DC795420Medicare PIN