Provider Demographics
NPI:1336167444
Name:OKAMOTO, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:OKAMOTO
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 1:283 S BUTLER ROAD
Mailing Address - Street 2:
Mailing Address - City:MT GRETNA
Mailing Address - State:PA
Mailing Address - Zip Code:17064
Mailing Address - Country:US
Mailing Address - Phone:717-273-8871
Mailing Address - Fax:
Practice Address - Street 1:283 S BUTLER ROAD
Practice Address - Street 2:
Practice Address - City:MT GRETNA
Practice Address - State:PA
Practice Address - Zip Code:17064
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-035445-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010594410001Medicaid
C34586Medicare UPIN
480455GHEMedicare ID - Type Unspecified