Provider Demographics
NPI:1760537542
Name:LOUDON DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:LOUDON DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMESE
Authorized Official - Middle Name:
Authorized Official - Last Name:SURANYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-986-5526
Mailing Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5676
Mailing Address - Country:US
Mailing Address - Phone:865-986-5526
Mailing Address - Fax:865-986-5493
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-986-5526
Practice Address - Fax:865-986-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDE3080OtherRRMEDICARE
TNP00284371OtherRRMEDICARE
TNDE3080OtherRRMEDICARE