Healthcare Provider Details

I. General information

NPI: 1083766208
Provider Name (Legal Business Name): ALEXIS F. TEPLICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/13/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD MEDICAL CENTER PLAZA, SUITE 601
CHARLOTTE NC
28203-5866
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-381-9900
  • Fax: 704-381-8848
Mailing address:
  • Phone: 704-381-9900
  • Fax: 704-381-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA90427
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013-02163
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: