MEDICARE: EDWARD E MISSINNE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	A181756	CA
2	2085R0202X	Diagnostic Radiology Physician	0101284837	VA

General Provider Information

NPI Number	:	1780046318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD E MISSINNE MD

Provider Business Mailing Address
First Line	:	2801 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1701
Country	:	US
Telephone Number	:	562-933-1550
Fax Number	:	562-933-8088

Provider Business Practice Location Address
First Line	:	2600 6TH ST SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-1702
Country	:	US
Telephone Number	:	844-722-4471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	04/24/2026

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