Provider Demographics
NPI:1891816286
Name:DERMATOLOGY ASSOCIATES INC. APMC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES INC. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-322-3535
Mailing Address - Street 1:324 CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5308
Mailing Address - Country:US
Mailing Address - Phone:318-322-3535
Mailing Address - Fax:
Practice Address - Street 1:324 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5308
Practice Address - Country:US
Practice Address - Phone:318-322-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024992207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1423238Medicaid
LA1423238Medicaid
I03808Medicare UPIN