Provider Demographics
NPI:1407176043
Name:NORTHSTAR DERMATOLOGY, PA
Entity Type:Organization
Organization Name:NORTHSTAR DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUTALEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-427-3376
Mailing Address - Street 1:8169 PRECINCT LINE RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-8607
Mailing Address - Country:US
Mailing Address - Phone:817-427-3376
Mailing Address - Fax:817-427-3379
Practice Address - Street 1:8169 PRECINCT LINE RD BLDG 2
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8607
Practice Address - Country:US
Practice Address - Phone:817-427-3376
Practice Address - Fax:817-427-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-06
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty