Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Northwest Dermatology & Laser Clinic PC

Organization Dermatology Physician · NPI 1376571364

Northwest Dermatology & Laser Clinic PC is a Dermatology Physician in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2006.

Licensed in
OR
In the registry since
2006
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1130 NW 22nd Ave Ste 330
Portland, OR 97210-2970
Phone: (503) 295-2366
Fax: (503) 295-3065
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence MD14681 (OR)

Record details

NPI number1376571364
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Bert Tavelli — President · (503) 295-2366
NPI enumeratedJune 29, 2006
Last updated in NPPESJune 1, 2016
Mailing addressPo Box 23200, Portland, OR 97281-3200

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