MEDICARE: STEELECREEK DERMATOLOGY PLLC

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	207N00000X	Dermatology Physician	94-00526	NC

General Provider Information

NPI Number	:	1447597752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEELECREEK DERMATOLOGY PLLC

Provider Business Mailing Address
First Line	:	13557 STEELECROFT PKWY
Second Line	:	SUITE 2500
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-7550
Country	:	US
Telephone Number	:	704-587-3200
Fax Number	:	704-587-0044

Provider Business Practice Location Address
First Line	:	13557 STEELECROFT PKWY
Second Line	:	SUITE 2500
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-7550
Country	:	US
Telephone Number	:	704-587-3200
Fax Number	:	704-587-0044

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JENNIFER L HELTON
Credential	:	M.D.
Telephone Number	:	704-587-3200

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	09/02/2013

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