Basic Information
| Provider Information | |||||||||
| NPI: | 1073710661 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKONKWO | ||||||||
| FirstName: | ONYEKA | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT STREET | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556180 | ||||||||
| FaxNumber: | 2159556410 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 CHESTNUT STREET | ||||||||
| Address2: | SUITE 701 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159559180 | ||||||||
| FaxNumber: | 2159556410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2007 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 003554 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD448550 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102853716 | 05 | PA | MEDICAID |