Provider Demographics
NPI:1063407625
Name:OKOYE, JOSEPH CHISO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHISO
Last Name:OKOYE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2202
Mailing Address - Country:US
Mailing Address - Phone:704-360-8893
Mailing Address - Fax:704-626-6515
Practice Address - Street 1:1220 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-2202
Practice Address - Country:US
Practice Address - Phone:704-360-8893
Practice Address - Fax:704-626-6515
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27261207R00000X, 208M00000X
NC200400929207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC272617Medicaid
NC89059FCMedicaid
SCP00708649OtherRR MEDICARE
SCAA06847100Medicare ID - Type Unspecified
NC89059FCMedicaid
SC272617Medicaid
SCAA06845019Medicare PIN