Provider Demographics
NPI:1043294739
Name:NNACHI, OKPANI MARTIN (MD)
Entity type:Individual
Prefix:
First Name:OKPANI
Middle Name:MARTIN
Last Name:NNACHI
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:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0117
Mailing Address - Country:US
Mailing Address - Phone:304-831-0073
Mailing Address - Fax:304-831-0076
Practice Address - Street 1:60 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-831-0073
Practice Address - Fax:304-831-0076
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21990208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002816Medicaid
I37400Medicare UPIN
WVOK9356021Medicare PIN