Active NPI
Edouard Misse', M.D.
- Surgery Physician
- Ahoskie, NC
National Provider Identifier
1265419113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 200100577
- Practice address
- 700 Academy St S
Ahoskie, NC 27910-3264 - Phone
- (252) 209-5404
- Fax
- (252) 209-3490
- NPI assigned
- Dec 30, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 200100577 | NC | Primary |
| Specialist | 174400000X | MD039134L | NC | |
| Specialist | 174400000X | PA200100577 | PA |
Addresses
Primary practice location
700 Academy St S
Ahoskie, NC 27910-3264
Mailing address
PO Box 1385
Ahoskie, NC 27910-1385
Phone (252) 209-5404
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129V4 | Other | NC | BLUECROSS BLUESHIELD |
| 89129V4 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD039134L | NC | MD | Specialist |
| PA200100577 | PA | MD | Specialist |
| 200100577 | NC | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392336000000",
"number": "1265419113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1385",
"city": "AHOSKIE",
"state": "NC",
"postal_code": "279101385",
"telephone_number": "252-209-5404",
"fax_number": "252-209-3490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 ACADEMY ST S",
"city": "AHOSKIE",
"state": "NC",
"postal_code": "279103264",
"telephone_number": "252-209-5404",
"fax_number": "252-209-3490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MISSE'",
"first_name": "EDOUARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-30",
"last_updated": "2014-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "200100577",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "MD039134L",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "PA",
"license": "PA200100577",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "129V4",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89129V4",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ahoskie, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.