Provider Demographics
NPI:1457340317
Name:OKOLO, EMMANUEL C (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:C
Last Name:OKOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:728 JUDIE LN
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1811 BETHLEHEM PIKE STE B211
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1111
Practice Address - Country:US
Practice Address - Phone:267-419-8189
Practice Address - Fax:215-367-3747
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426910207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I38465Medicare UPIN
PA093697Medicare PIN