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General NPI Number Information
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NPI Number | 1194479725
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Entity Type | Organization
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Legal Business Name | NORTHSHORE DERMATOLOGY, LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 393 HIGHWAY 21 STE 550
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City | MADISONVILLE
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State | LA
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Zip | 70447-3447
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Country | US
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Telephone | 985-641-5198
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Fax | 866-755-7181
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Provider Business Mailing Address
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Address Line | 393 HIGHWAY 21 STE 550
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City | MADISONVILLE
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State | LA
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Zip | 70447-3447
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Country | US
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Telephone | 985-641-5198
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Fax | 866-755-7181
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC TABOR
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Credential | MD
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Telephone | 985-641-5198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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