Individual
WISSAM EDWARD NADRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
275 N. HWY 16. SUITE: 103, LAKESHORE PEDIATRIC CENTER, DENVER, NC 28037
(704) 489-8401
(704) 489-8404
Mailing address
LAKESHORE PEDIATRIC CENTER, P.O. BOX 1470, DENVER, NC 28037
(704) 489-8401
(704) 489-8404
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2000-00103
NC
208000000X
Pediatrics Physician
27533
AZ
208000000X
Pediatrics Physician
A67393
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950140
—
NC
05
—
89126ER
—
NC
Enumeration date
10/03/2005
Last updated
03/07/2023
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