Provider Demographics
NPI:1295993988
Name:T & G DERMATOLOGY APMC
Entity type:Organization
Organization Name:T & G DERMATOLOGY APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIPPINCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-454-2997
Mailing Address - Street 1:3800 HOUMA BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4182
Mailing Address - Country:US
Mailing Address - Phone:504-454-2997
Mailing Address - Fax:504-456-5939
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4182
Practice Address - Country:US
Practice Address - Phone:504-454-2997
Practice Address - Fax:504-456-5939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010404207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490709Medicaid
LA1120421Medicaid
LA1491446Medicaid
LAG90759Medicare UPIN
LA4A327Medicare PIN
LA1491446Medicaid
LAB65707Medicare UPIN
LAH30794Medicare UPIN
LA1490709Medicaid