Provider Demographics
NPI:1255505772
Name:UPTOWN DERMATOLOGY PA
Entity Type:Organization
Organization Name:UPTOWN DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MULLANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-623-2336
Mailing Address - Street 1:2211 NORFOLK STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4030
Mailing Address - Country:US
Mailing Address - Phone:713-623-2336
Mailing Address - Fax:713-623-4441
Practice Address - Street 1:2211 NORFOLK STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4030
Practice Address - Country:US
Practice Address - Phone:713-623-2336
Practice Address - Fax:713-623-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7284207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005JYOtherBLUE CROSS BLUE SHIELD
00959UMedicare PIN