Provider Demographics
NPI:1801897582
Name:OKONKWO, SYLVESTER OBANYA (MD)
Entity type:Individual
Prefix:DR
First Name:SYLVESTER
Middle Name:OBANYA
Last Name:OKONKWO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6192 OXON HILL RD
Mailing Address - Street 2:STE 507
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3114
Mailing Address - Country:US
Mailing Address - Phone:301-839-0800
Mailing Address - Fax:301-839-8088
Practice Address - Street 1:6192 OXON HILL RD
Practice Address - Street 2:STE 507
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3114
Practice Address - Country:US
Practice Address - Phone:301-839-0800
Practice Address - Fax:301-839-8088
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0055314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD113703400Medicaid
MD113703400Medicaid
00A2O4B95Medicare PIN