Provider Demographics
NPI:1548754930
Name:ISSA, MAGDY (DPM)
Entity type:Individual
Prefix:
First Name:MAGDY
Middle Name:
Last Name:ISSA
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15114 TORRENCE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-5829
Mailing Address - Country:US
Mailing Address - Phone:515-745-3469
Mailing Address - Fax:606-218-7506
Practice Address - Street 1:508 MEETING ST
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-7535
Practice Address - Country:US
Practice Address - Phone:727-796-6900
Practice Address - Fax:727-669-8417
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY283676213ES0103X
SC768213ES0103X
NC759213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD7683Medicaid