Provider Demographics
NPI:1063450575
Name:BENGSON, LUDOVICO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUDOVICO
Middle Name:
Last Name:BENGSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64374
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4374
Mailing Address - Country:US
Mailing Address - Phone:410-328-6720
Mailing Address - Fax:410-328-1674
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:SUITE 300 6TH FL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-6720
Practice Address - Fax:410-328-1674
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025993207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCA8702OtherRAILROAD GROUP#
MDCA8702OtherRAILROAD GROUP#
MDP00100045Medicare PIN
MDCA8702Medicare PIN
MDB66972Medicare UPIN