Provider Demographics
NPI:1043768427
Name:DERMATOLOGY NOLA
Entity Type:Organization
Organization Name:DERMATOLOGY NOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:504-455-3180
Mailing Address - Street 1:4425 CONLIN ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2181
Mailing Address - Country:US
Mailing Address - Phone:504-455-3180
Mailing Address - Fax:504-885-2512
Practice Address - Street 1:4425 CONLIN ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2181
Practice Address - Country:US
Practice Address - Phone:504-455-3180
Practice Address - Fax:504-885-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty