Provider Demographics
NPI:1730216490
Name:OKAY, ASHANTI NEAL (MD)
Entity type:Individual
Prefix:
First Name:ASHANTI
Middle Name:NEAL
Last Name:OKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHANTI
Other - Middle Name:NEAL
Other - Last Name:BASKERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2306 VICTORIA CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-9679
Mailing Address - Country:US
Mailing Address - Phone:804-380-2604
Mailing Address - Fax:804-336-2278
Practice Address - Street 1:4823 S LABURNUM AVE STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2713
Practice Address - Country:US
Practice Address - Phone:804-277-9631
Practice Address - Fax:804-336-2278
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007639406Medicaid
VAC09633OtherGROUP PTAN