Provider Demographics
NPI:1902429715
Name:OKORIE, ERNIE
Entity Type:Individual
Prefix:
First Name:ERNIE
Middle Name:
Last Name:OKORIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2231
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20122-2231
Mailing Address - Country:US
Mailing Address - Phone:703-655-2804
Mailing Address - Fax:
Practice Address - Street 1:5270 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2943
Practice Address - Country:US
Practice Address - Phone:703-655-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor