Healthcare Provider Details

I. General information

NPI: 1609982164
Provider Name (Legal Business Name): TULANE DEPARTMENT OF DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE TB 36
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1614 HESIOD ST
METAIRIE LA
70005-3218
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5114
  • Fax:
Mailing address:
  • Phone: 504-301-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD.14822R
License Number StateLA

VIII. Authorized Official

Name: DR. ASHLEY NELL COUNCE
Title or Position: DERMATOLOGY RESIDENT THIRD YEAR
Credential: M.D.
Phone: 504-988-5114