Healthcare Provider Details

I. General information

NPI: 1043768427
Provider Name (Legal Business Name): DERMATOLOGY NOLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 CONLIN ST
METAIRIE LA
70006-2181
US

IV. Provider business mailing address

4425 CONLIN ST
METAIRIE LA
70006-2181
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-3180
  • Fax: 504-885-2512
Mailing address:
  • Phone: 504-455-3180
  • Fax: 504-885-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM PATRICK COLEMAN IV
Title or Position: PRESIDENT
Credential: MD
Phone: 504-455-3180