Provider Demographics
NPI:1285260588
Name:UPTOWN DERMATOLOGY LLC
Entity type:Organization
Organization Name:UPTOWN DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-508-4309
Mailing Address - Street 1:8016 CONSTITUTION PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7628
Mailing Address - Country:US
Mailing Address - Phone:505-508-4309
Mailing Address - Fax:505-835-5687
Practice Address - Street 1:8016 CONSTITUTION PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7628
Practice Address - Country:US
Practice Address - Phone:505-508-4309
Practice Address - Fax:505-835-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center