Provider Demographics
NPI:1386829208
Name:OTEY, ASIM SALIH (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIM
Middle Name:SALIH
Last Name:OTEY
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 1:717 GREEN VALLEY RD STE 200-179
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2155
Mailing Address - Country:US
Mailing Address - Phone:336-609-0499
Mailing Address - Fax:
Practice Address - Street 1:2401 S SIDE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-3311
Practice Address - Country:US
Practice Address - Phone:336-609-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238535208100000X
NC2008-00366208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386829208Medicaid
NC5909721Medicaid
SCN66008Medicaid
SCN66008Medicaid
NC2022398Medicare PIN