Provider Demographics
NPI:1942344593
Name:ACADEMIC DERMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ACADEMIC DERMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-832-6612
Mailing Address - Street 1:PO BOX 6793
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009-6793
Mailing Address - Country:US
Mailing Address - Phone:504-832-6612
Mailing Address - Fax:504-832-6613
Practice Address - Street 1:3421 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3759
Practice Address - Country:US
Practice Address - Phone:504-832-6612
Practice Address - Fax:504-832-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5D430Medicare ID - Type Unspecified