Provider Demographics
NPI:1740344555
Name:A W DERMATOPATHOLOGY SERVICE
Entity type:Organization
Organization Name:A W DERMATOPATHOLOGY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALUN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-896-9023
Mailing Address - Street 1:PO BOX 15259
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70175-5259
Mailing Address - Country:US
Mailing Address - Phone:504-896-9023
Mailing Address - Fax:504-896-9093
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:STE. 306
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-896-9023
Practice Address - Fax:504-896-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D1016329291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CF36Medicare ID - Type UnspecifiedGROUP NUMBER