Northwest Dermatology & Laser Clinic Pc

LBN: Northwest Dermatology & Laser Clinic Pc
Northwest Dermatology & Laser Clinic Pc is an health care organization with primary practice located at 1130 Nw 22Nd Ave Ste 330 , Portland OR 97210-2970. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. Northwest Dermatology & Laser Clinic Pc can be contacted via phone (503) 295-2366, or through Tavelli, Bert G via phone (503) 295-2366.

Contact Information

Primary practice address
1130 Nw 22Nd Ave Ste 330 Portland OR 97210-2970
Fax: (503) 295-3065
Website:
Authorized official contact:
Name: Tavelli, Bert G Doctor of Medicine (MD)

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X MD14681 Oregon

Profile Details

NPI number 1376571364
LBN Legal business name Northwest Dermatology & Laser Clinic Pc
DBA Doing business as
Authorized official Tavelli, Bert G Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jun 29th, 2006
Last updated Jun 1st, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376571364 NPPES
Oregon Other DD5356 RAILROAD MEDICARE
Oregon MEDICAID 028071 RAILROAD MEDICARE

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