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NPI Code Detail

MEDICARE: DERMATOLOGY CLINIC A PROFESSIONAL MEDICAL CORPORATION

MEDICARE: DERMATOLOGY CLINIC A PROFESSIONAL MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972591170
Entity Type Code : Organization
Provider Name (Legal Business Name) : DERMATOLOGY CLINIC A PROFESSIONAL MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 5326 O'DONOVAN DRIVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-9153
Country : US
Telephone Number : 225-769-7546
Fax Number : 225-769-0471
Provider Business Practice Location Address
First Line : 5326 O'DONOVAN DRIVE
Second Line :
City : BATON ROUGE
State : LA
Zip : 70808-9153
Country : US
Telephone Number : 225-769-7546
Fax Number : 225-769-0471
Authorized Official
Title or Position : MD PRESIDENT
Name : DR. HARRY A BURGLASS JR.
Credential : MD
Telephone Number : 225-769-7546
Provider Enumeration Date : 10/11/2005
Last Update Date : 04/04/2008

Similar Medicare Providers

1033113980 — MS. VICKIE SUE RICE PA-C
Practice Location Address:
5247 DIDESSE DR
BATON ROUGE, LA
70808-9153
Practice Phone: 225-215-2193
Practice Fax: 225-215-2194
1720087828 — LYNN BERNAIRD PENNINGTON FNP
Practice Location Address:
5247 DIDESSE DR
BATON ROUGE, LA
70808-9153
Practice Phone: 225-765-3076
Practice Fax: 225-765-3090
1720088529 — DR. WILLIAM PATRICK GAHAN M.D.
Practice Location Address:
5247 DIDESSE DR
BATON ROUGE, LA
70808-9153
Practice Phone: 225-765-3076
Practice Fax: 225-765-3090
1386631935 — AMIE B SHANNON M.D.
Practice Location Address:
5326 O'DONOVAN DRIVE
BATON ROUGE, LA
70808-9153
Practice Phone: 225-769-7546
Practice Fax: 225-769-0471
1710976915 — JOSEPH A ACOSTA MD
Practice Location Address:
5247 DIDESSE DR
BATON ROUGE, LA
70808-9153
Practice Phone: 225-215-2193
Practice Fax: 225-215-2194
1407877426 — MADELEINE C HECK MD
Practice Location Address:
5247 DIDESSE DR
BATON ROUGE, LA
70808-9153
Practice Phone: 225-374-0082
Practice Fax: 225-765-9150

Directions to “DERMATOLOGY CLINIC A PROFESSIONAL MEDICAL CORPORATION ” Practice Location

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