Provider Demographics
NPI:1124109830
Name:ASADI, KATHERINE ANN (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:ASADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:ASSADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4546 NC 87 S
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-0212
Mailing Address - Country:US
Mailing Address - Phone:919-499-5151
Mailing Address - Fax:919-499-5147
Practice Address - Street 1:4546 NC 87 S
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332-0212
Practice Address - Country:US
Practice Address - Phone:919-499-5151
Practice Address - Fax:919-499-5147
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0054970207R00000X
NC2016-00507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD023N871FMedicare PIN