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 provides Dermatology Physician services 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 Not confirmed with CMS for 10 years — call before visiting
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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