Healthcare Provider Details

I. General information

NPI: 1336680743
Provider Name (Legal Business Name): ELEVATED DERMATOLOGY AND SKIN CANCER SURGERY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 PARKGLENN WAY SUITE 100
PARKER CO
80138-3883
US

IV. Provider business mailing address

10345 PARKGLENN WAY SUITE 100
PARKER CO
80138-3883
US

V. Phone/Fax

Practice location:
  • Phone: 720-851-5200
  • Fax: 720-851-5222
Mailing address:
  • Phone: 720-851-5200
  • Fax: 720-851-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0057198
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberDR.0057198
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberDR.0057198
License Number StateCO

VIII. Authorized Official

Name: DR. CHRISTOPHER A MESSANA
Title or Position: OWNER
Credential: DO
Phone: 720-851-5200