Provider Demographics
NPI:1235118142
Name:LUDEWIG, VICTOR WERNER (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:WERNER
Last Name:LUDEWIG
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 1:77 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6438
Mailing Address - Country:US
Mailing Address - Phone:518-562-7462
Mailing Address - Fax:518-834-7797
Practice Address - Street 1:77 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6438
Practice Address - Country:US
Practice Address - Phone:518-562-7462
Practice Address - Fax:518-834-7797
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1123371207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00470773Medicaid
B81964Medicare UPIN
NY00470773Medicaid