Provider Demographics
NPI:1083907612
Name:MESIDOR, LUDMILAR (DO)
Entity Type:Individual
Prefix:DR
First Name:LUDMILAR
Middle Name:
Last Name:MESIDOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 ROUTE 9W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-6763
Mailing Address - Country:US
Mailing Address - Phone:914-302-3998
Mailing Address - Fax:
Practice Address - Street 1:3125 ROUTE 9W
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-6763
Practice Address - Country:US
Practice Address - Phone:914-302-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC519102084P0800X
OH34.0133522084P0800X
VA01022052902084P0800X
NC2018-015182084P0800X
KY043272084P0800X
DCDO0347252084P0800X
NY2865412084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry