Provider Demographics
NPI:1821380502
Name:OKRIE, ANTHONY JOSEPH (IDC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:OKRIE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 BURNINGTREE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:252-665-0803
Mailing Address - Fax:
Practice Address - Street 1:378 BURNINGTREE DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3106
Practice Address - Country:US
Practice Address - Phone:252-665-0803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman