Provider Demographics
NPI:1265688824
Name:DRAGO LUDOWIEG, CARLOS EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EDUARDO
Last Name:DRAGO LUDOWIEG
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 1:425 W 3RD AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1961
Mailing Address - Country:US
Mailing Address - Phone:229-312-1022
Mailing Address - Fax:229-436-6946
Practice Address - Street 1:425 W 3RD AVE STE 600
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1961
Practice Address - Country:US
Practice Address - Phone:229-312-1022
Practice Address - Fax:229-436-6946
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS729-L207R00000X
GA81127207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01452045OtherRR MEDICARE
KY7100358980Medicaid
KY7100358980Medicaid