Provider Demographics
NPI:1598949877
Name:CHARLENE Q OKONSKI DO PA
Entity Type:Organization
Organization Name:CHARLENE Q OKONSKI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:OKOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-205-2666
Mailing Address - Street 1:6210 SCOTT ST
Mailing Address - Street 2:UNIT 216
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3901
Mailing Address - Country:US
Mailing Address - Phone:941-205-2666
Mailing Address - Fax:941-205-2665
Practice Address - Street 1:6210 SCOTT ST
Practice Address - Street 2:UNIT 216
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3901
Practice Address - Country:US
Practice Address - Phone:941-205-2666
Practice Address - Fax:941-205-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-22
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7415207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX59148Medicare UPIN