Provider Demographics
NPI:1356321962
Name:LEDNICKY, BARBARA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANNE
Last Name:LEDNICKY
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 1:1661 E CAMELBACK RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3911
Mailing Address - Country:US
Mailing Address - Phone:602-263-9550
Mailing Address - Fax:602-263-1150
Practice Address - Street 1:1661 E CAMELBACK RD
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3911
Practice Address - Country:US
Practice Address - Phone:602-263-9550
Practice Address - Fax:602-263-1150
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ188939Medicaid