Healthcare Provider Details

I. General information

NPI: 1548754930
Provider Name (Legal Business Name): MAGDY ISSA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MEETING ST
WEST COLUMBIA SC
29169-7535
US

IV. Provider business mailing address

15114 TORRENCE BRANCH RD
CHARLOTTE NC
28278-5829
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-6900
  • Fax: 727-669-8417
Mailing address:
  • Phone: 515-745-3469
  • Fax: 606-218-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number283676
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number768
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: