Provider Demographics
NPI:1447597752
Name:STEELECREEK DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:STEELECREEK DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-587-3200
Mailing Address - Street 1:13557 STEELECROFT PKWY
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7550
Mailing Address - Country:US
Mailing Address - Phone:704-587-3200
Mailing Address - Fax:704-587-0044
Practice Address - Street 1:13557 STEELECROFT PKWY
Practice Address - Street 2:SUITE 2500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7550
Practice Address - Country:US
Practice Address - Phone:704-587-3200
Practice Address - Fax:704-587-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00526207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC304Medicare PIN