Provider Demographics
NPI:1164875746
Name:OSEI, OTIS (DNP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:OTIS
Middle Name:
Last Name:OSEI
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 AQUEDUCT RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6209
Mailing Address - Country:US
Mailing Address - Phone:301-613-0063
Mailing Address - Fax:
Practice Address - Street 1:8501 AQUEDUCT RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-6209
Practice Address - Country:US
Practice Address - Phone:301-613-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001210086163W00000X
MDAC002834367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse