Provider Demographics
NPI:1376178137
Name:BARDIN DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:BARDIN DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-301-6621
Mailing Address - Street 1:2505 RAINWATER RD
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-3020
Mailing Address - Country:US
Mailing Address - Phone:504-301-6621
Mailing Address - Fax:
Practice Address - Street 1:111 N ROYAL ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-3851
Practice Address - Country:US
Practice Address - Phone:504-301-6621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty