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General NPI Number Information
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NPI Number | 1053579862
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Entity Type | Organization
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Legal Business Name | DERMASURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 111 VETERANS MEMORIAL BLVD STE 406
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City | METAIRIE
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State | LA
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Zip | 70005-3061
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Country | US
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Telephone | 504-838-8225
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746767
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City | ATLANTA
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State | GA
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Zip | 30374-6767
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Country | US
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Telephone | 225-303-9500
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. EDWARD LAIN
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Credential | M.D.
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Telephone | 225-303-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | MD.200242
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | MD.200242
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | MD.200242
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD.200242
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License Number State | LA
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