Healthcare Provider Details

I. General information

NPI: 1053579862
Provider Name (Legal Business Name): DERMASURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VETERANS MEMORIAL BLVD STE 406
METAIRIE LA
70005-3061
US

IV. Provider business mailing address

PO BOX 746767
ATLANTA GA
30374-6767
US

V. Phone/Fax

Practice location:
  • Phone: 504-838-8225
  • Fax:
Mailing address:
  • Phone: 225-303-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD.200242
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD.200242
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD.200242
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.200242
License Number StateLA

VIII. Authorized Official

Name: DR. EDWARD LAIN
Title or Position: MD
Credential: M.D.
Phone: 225-303-9500