Provider Demographics
NPI:1306284591
Name:KLINGER & MARSHALL DERMATOLOGY, LLC
Entity type:Organization
Organization Name:KLINGER & MARSHALL DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-319-2608
Mailing Address - Street 1:2600 BELLE CHASSE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 BELLE CHASSE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-319-2608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADU1676OtherRAILROAD MEDICARE
LADU1676OtherRAILROAD MEDICARE