Healthcare Provider Details

I. General information

NPI: 1043290331
Provider Name (Legal Business Name): STEPHEN ERIC ERLANDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CHATHAM MEDICAL PARK
ELKIN NC
28621-2482
US

IV. Provider business mailing address

600 CHATHAM MEDICAL PARK
ELKIN NC
28621-2482
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-4819
  • Fax: 336-835-6934
Mailing address:
  • Phone: 336-835-4819
  • Fax: 336-835-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20540
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: