Provider Demographics
NPI:1275656514
Name:LUDKA, LESLIE M (CNM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:LUDKA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CAMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1008
Mailing Address - Country:US
Mailing Address - Phone:617-665-2229
Mailing Address - Fax:
Practice Address - Street 1:10 CAMELIA AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1008
Practice Address - Country:US
Practice Address - Phone:617-665-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149422367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN0181Medicare ID - Type Unspecified