MEDICARE: DR. MARK FREDERICK STEGELMAN M.D.

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	208000000X	Pediatrics Physician	034721	GA
2	208000000X	Pediatrics Physician	ME89382	FL
3	208000000X	Pediatrics Physician	18853	MS
4	208000000X	Pediatrics Physician	27667	SC
5	208000000X	Pediatrics Physician		NC

General Provider Information

NPI Number	:	1790724433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK FREDERICK STEGELMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 133091
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30333-3091
Country	:	US
Telephone Number	:	404-881-6600
Fax Number	:	404-881-1066

Provider Business Practice Location Address
First Line	:	1356 WAYNE AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-3233
Country	:	US
Telephone Number	:	404-881-6600
Fax Number	:	404-881-1066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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