Provider Demographics
NPI:1386842417
Name:DERMSOUTH, PA
Entity type:Organization
Organization Name:DERMSOUTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-791-9966
Mailing Address - Street 1:6700 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE #500
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-791-9966
Mailing Address - Fax:
Practice Address - Street 1:10970 SHADOW CREEK PKWY
Practice Address - Street 2:SUITE 340
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0100
Practice Address - Country:US
Practice Address - Phone:713-791-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty