Healthcare Provider Details

I. General information

NPI: 1386620136
Provider Name (Legal Business Name): OLGA MARIE OTTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 FOXRIDGE RD
CHAPEL HILL NC
27514-9020
US

IV. Provider business mailing address

108 FOXRIDGE RD
CHAPEL HILL NC
27514-9020
US

V. Phone/Fax

Practice location:
  • Phone: 919-358-9438
  • Fax:
Mailing address:
  • Phone: 919-358-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2006-00712
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: