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LAKESHORE PEDIATRIC CENTER, P.A.
NPI 1366650707
Pediatrics in Denver, NC

Active since May 18, 2007
275 N HWY 16, SUITE: 103 LAKESHORE PEDIATRIC CENTER., DENVER, NC 28037(704) 489-8401(704) 489-8404 Get Directions Write a Review

NPPES record last updated: February 4, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Lakeshore Pediatric Center, P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKESHORE PEDIATRIC CENTER, P.A. (NPI 1366650707) is a healthcare organization registered as a pediatrics in Denver, North Carolina and active in the NPI registry since May 2007. The organization lists Wissam Nadra, President, as its authorized official.

NPPES Registry Identity

NPI1366650707
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLAKESHORE PEDIATRIC CENTER, P.A.
Location Address275 N HWY 16, SUITE: 103 LAKESHORE PEDIATRIC CENTER.Denver, NC 28037
Mailing Address275 N Hwy 16, Suite: 103 Lakeshore Pediatric Center.Denver, NC 28037 · (704) 489-8401 · Fax (704) 489-8404
Phone(704) 489-8401
Fax(704) 489-8404
Organization SubpartNo
Authorized OfficialWissam NadraPresident · (704) 489-8401
Enumeration DateMay 18, 2007
Last NPPES UpdateFebruary 4, 2011
✔ NPI 1366650707 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in NC · 2000-00103
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
275 N HWY 16, Denver, NC 28037
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Other Identifiers 2

Medicaid5950140NC
Medicare UPINH11781NC

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D1027694

Lakeshore Pediatric Center · Denver, NC
Expired · Jul 6, 2026
CLIA Number34D1027694
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2024
Certificate Expiration DateJuly 6, 2026
Laboratory DirectorWissam E. Nadra
Laboratory Phone(704) 489-8401
Laboratory LocationLakeshore Pediatric Center635 N Highway 16, Denver, NC 28037
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lakeshore Pediatric Center, P.A.'s NPI number?

The NPI number for Lakeshore Pediatric Center, P.A. is 1366650707. It was assigned to this organization in the NPPES registry on May 18, 2007.

Where is Lakeshore Pediatric Center, P.A. located?

Lakeshore Pediatric Center, P.A. is located at 275 N Hwy 16 Suite: 103 Lakeshore Pediatric Center., Denver, NC 28037. The listed phone number is (704) 489-8401.

What is Lakeshore Pediatric Center, P.A.'s specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for Lakeshore Pediatric Center, P.A. was last updated on February 4, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.