Provider Demographics
NPI:1275622656
Name:RADZIEVSKA, LUDMILA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUDMILA
Middle Name:A
Last Name:RADZIEVSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1346
Mailing Address - Country:US
Mailing Address - Phone:215-969-6394
Mailing Address - Fax:
Practice Address - Street 1:6722 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2301
Practice Address - Country:US
Practice Address - Phone:215-708-1645
Practice Address - Fax:215-708-1650
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4212832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001974222Medicaid
PA001974222Medicaid
PA074622D0EMedicare ID - Type Unspecified
NJ070942Medicare ID - Type UnspecifiedNJ MED ID