Provider Demographics
NPI:1053315499
Name:AASSAR, OLE SAMI (MD)
Entity Type:Individual
Prefix:
First Name:OLE
Middle Name:SAMI
Last Name:AASSAR
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 1:700 E MOREHEAD ST
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2788
Mailing Address - Country:US
Mailing Address - Phone:704-334-7800
Mailing Address - Fax:
Practice Address - Street 1:700 E MOREHEAD ST
Practice Address - Street 2:STE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2788
Practice Address - Country:US
Practice Address - Phone:704-334-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC226372085R0202X, 2085R0204X
NC2001002052085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00206Medicaid
NC89128P5Medicaid
NC2284260Medicare PIN
NC89128P5Medicaid
SCH283666685Medicare PIN