Organization
LAKESHORE PEDIATRIC CENTER, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WISSAM NADRA MD (PRESIDENT)
(704) 489-8401
Entity
Organization
Contact information
Practice address
275 N HWY 16, SUITE: 103 LAKESHORE PEDIATRIC CENTER., DENVER, NC 28037
(704) 489-8401
(704) 489-8404
Mailing address
275 N HWY 16, SUITE: 103 LAKESHORE PEDIATRIC CENTER., DENVER, NC 28037
(704) 489-8401
(704) 489-8404
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2000-00103
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5950140
—
NC
Enumeration date
05/18/2007
Last updated
02/04/2011
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