Wissam Edward Nadra, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2000-00103 Issued in NC

Practice address

275 N. Hwy 16. Suite: 103
Lakeshore Pediatric Center
Denver, NC 28037

Phone

(704) 489-8401

Fax

(704) 489-8404

NPI assigned

Oct 3, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: wnadra@lakeshorepeds.opdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeshore Pediatric Center, P.a.

  • Pediatrics Physician
  • Denver, NC
  • NPI 1366650707
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1154318350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LAKESHORE PEDIATRIC CENTER",
            "address_2": "P.O. BOX 1470",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "28037",
            "telephone_number": "704-489-8401",
            "fax_number": "704-489-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 N. HWY 16. SUITE: 103",
            "address_2": "LAKESHORE PEDIATRIC CENTER",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "28037",
            "telephone_number": "704-489-8401",
            "fax_number": "704-489-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADRA",
        "first_name": "WISSAM",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2000-00103",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A67393",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "27533",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950140",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89126ER",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Taylor Moss, DO
• Matthew Bynum Motteler, O.D.
• Sarah Murchison, MED, LPCA
• Ashlee Nicole Myers
• Nahi Nadra
• Tara Ghatge Nagaraja
• Scott Nagel, D.M.D.
• Nathen Ellis DDS PLLC (Denver Dental Arts)
• Laura Eileen Needham, DPT
• Albi Ngjelo, DMD

• Pediatrics Physician in Denver, NC
• Providers in Denver, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.