Provider Demographics
NPI:1437203619
Name:OKOLI, ALPHONSUS EZIAGWU (M D)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSUS
Middle Name:EZIAGWU
Last Name:OKOLI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT ROAD
Mailing Address - Street 2:SUITE U-6
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:240-542-4850
Mailing Address - Fax:240-965-7311
Practice Address - Street 1:6201 GREENBELT ROAD
Practice Address - Street 2:SUITE U-6
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:240-542-4850
Practice Address - Fax:240-965-7311
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8964109Medicaid
NC2228903AMedicare ID - Type Unspecified
NCG31286Medicare UPIN