Healthcare Provider Details

I. General information

NPI: 1588173447
Provider Name (Legal Business Name): CAPITAL DERMATOLOGY OF NC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 CREEDMOOR RD STE 105
RALEIGH NC
27613-1695
US

IV. Provider business mailing address

7209 CREEDMOOR RD STE 105
RALEIGH NC
27613-1695
US

V. Phone/Fax

Practice location:
  • Phone: 919-307-9461
  • Fax:
Mailing address:
  • Phone: 919-307-9461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number65395
License Number StateNC

VIII. Authorized Official

Name: MR. MICHAEL R STEELE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 919-809-9001