Provider Demographics
NPI:1518961945
Name:OKEKE, VINCENT I (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:I
Last Name:OKEKE
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 1:8909 OLD BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2528
Mailing Address - Country:US
Mailing Address - Phone:301-868-7274
Mailing Address - Fax:301-868-0693
Practice Address - Street 1:8909 OLD BRANCH AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2528
Practice Address - Country:US
Practice Address - Phone:301-868-7274
Practice Address - Fax:301-868-0693
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046312207R00000X
MDD46312208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD511304100Medicaid
J489-0006OtherCAREFIRST- I CARE INC
MD607MK311Medicare ID - Type UnspecifiedI CARE INC
MD511304100Medicaid
G85179Medicare UPIN