Active NPI
Issa Elgendy, MD
- Pediatrics Physician
- Fayetteville, NC
National Provider Identifier
1114920030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 200000049
- Practice address
- 1262 Oliver St
Ste B
Fayetteville, NC 28304-4449 - Phone
- (910) 609-4801
- Fax
- (910) 609-5406
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 200000049 | NC | Primary |
Addresses
Primary practice location
1262 Oliver St
Ste B
Fayetteville, NC 28304-4449
Mailing address
PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 609-6448
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891239J | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200000049 | NC | MD | Anesthesiologist Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1114920030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40908",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283090908",
"telephone_number": "910-609-6448",
"fax_number": "910-609-7040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1262 OLIVER ST",
"address_2": "STE B",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283044449",
"telephone_number": "910-609-4801",
"fax_number": "910-609-5406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELGENDY",
"first_name": "ISSA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "200000049",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891239J",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.