Provider Demographics
NPI:1851865869
Name:SOUTHERN DERMATOLOGY OF NEW ORLEANS
Entity Type:Organization
Organization Name:SOUTHERN DERMATOLOGY OF NEW ORLEANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-891-8004
Mailing Address - Street 1:2030 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-6240
Mailing Address - Country:US
Mailing Address - Phone:504-891-8004
Mailing Address - Fax:
Practice Address - Street 1:2633 NAPOLEON AVE STE 1020
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7403
Practice Address - Country:US
Practice Address - Phone:504-891-8004
Practice Address - Fax:504-891-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty