Provider Demographics
NPI:1700415817
Name:OKORIE, STEPHANIE C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:OKORIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:OTUWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 PLAZA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4019
Mailing Address - Country:US
Mailing Address - Phone:724-379-6850
Mailing Address - Fax:
Practice Address - Street 1:800 PLAZA DR STE 210
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15012-4019
Practice Address - Country:US
Practice Address - Phone:724-379-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT221525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program