Provider Demographics
NPI:1508911256
Name:BROWNSBORO DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:BROWNSBORO DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-339-2922
Mailing Address - Street 1:4938 BROWNSBORO RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6374
Mailing Address - Country:US
Mailing Address - Phone:502-339-2922
Mailing Address - Fax:502-339-2912
Practice Address - Street 1:4938 BROWNSBORO RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6374
Practice Address - Country:US
Practice Address - Phone:502-339-2922
Practice Address - Fax:502-339-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26744207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty