NORTHWEST DERMATOLOGY & LASER CLINIC PC
NPI 1376571364
Dermatology in Portland, OR

Active since June 29, 2006
1130 NW 22ND AVE STE 330, PORTLAND, OR 97210(503) 295-2366(503) 295-3065 Get Directions Write a Review

NPPES record last updated: June 1, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Northwest Dermatology & Laser Clinic Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NORTHWEST DERMATOLOGY & LASER CLINIC PC (NPI 1376571364) is a healthcare organization registered as a dermatology in Portland, Oregon and active in the NPI registry since June 2006. The organization lists Bert G Tavelli, President, as its authorized official.

NPPES Registry Identity

NPI1376571364
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameNORTHWEST DERMATOLOGY & LASER CLINIC PC
Location Address1130 NW 22ND AVE STE 330Portland, OR 97210-2970
Mailing AddressPo Box 23200Portland, OR 97281-3200 · (503) 968-4620 · Fax (503) 968-2779
Fax(503) 295-3065
Organization SubpartNo
Authorized OfficialBert G TavelliPresident · (503) 295-2366
Enumeration DateJune 29, 2006
Last NPPES UpdateJune 1, 2016
NPI 1376571364 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in OR · MD14681
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
1130 NW 22ND AVE STE 330, Portland, OR 97210

Other Identifiers 4

Medicare UPINE84405OR
Medicaid028071OR
Medicare PINR131623OR
OtherDD5356OR · Railroad Medicare

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Northwest Dermatology & Laser Clinic PC's NPI number?

The NPI number for Northwest Dermatology & Laser Clinic PC is 1376571364. It was assigned to this organization in the NPPES registry on June 29, 2006.

Where is Northwest Dermatology & Laser Clinic PC located?

Northwest Dermatology & Laser Clinic PC is located at 1130 NW 22nd Ave Ste 330, Portland, OR 97210. The listed phone number is (503) 295-2366.

What is Northwest Dermatology & Laser Clinic PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Northwest Dermatology & Laser Clinic PC was last updated on June 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.