Provider Demographics
NPI:1689957169
Name:SANOVA DERMATOLOGY PLLC
Entity Type:Organization
Organization Name:SANOVA DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-266-0007
Mailing Address - Street 1:1601 E PFLUGERVILLE PKWY STE 1201
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6148
Mailing Address - Country:US
Mailing Address - Phone:512-837-3376
Mailing Address - Fax:512-837-3377
Practice Address - Street 1:12319 N MOPAC EXPY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2486
Practice Address - Country:US
Practice Address - Phone:512-837-3376
Practice Address - Fax:512-837-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty