Provider Demographics
NPI:1720011950
Name:OKONKWO, AMBROSE SUNDAY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBROSE
Middle Name:SUNDAY
Last Name:OKONKWO
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 1:2104 N HERRITAGE ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-2222
Mailing Address - Country:US
Mailing Address - Phone:252-522-3663
Mailing Address - Fax:252-522-3660
Practice Address - Street 1:2104 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-2222
Practice Address - Country:US
Practice Address - Phone:252-522-3663
Practice Address - Fax:252-522-3660
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900633207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126AGMedicaid
NC229770AMedicare PIN
NC89126AGMedicaid