MEDICARE: SURGICAL SPECIALISTS OF CHARLOTTE, P.A.

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	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518958818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALISTS OF CHARLOTTE, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 33369
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28233-3369
Country	:	US
Telephone Number	:	704-333-0741
Fax Number	:	704-365-2073

Provider Business Practice Location Address
First Line	:	7300 CARMEL EXECUTIVE PARK DR STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1336
Country	:	US
Telephone Number	:	704-364-8100
Fax Number	:	704-365-2073

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LESLIE T. WEBSTER III
Credential	:	M.D.
Telephone Number	:	704-364-8100

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	02/08/2022

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