Provider Demographics
NPI:1407250210
Name:LUDWIG, MATTHEW (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 FOREST HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1755
Mailing Address - Country:US
Mailing Address - Phone:201-919-1380
Mailing Address - Fax:
Practice Address - Street 1:566 BROWNSON RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21402-5006
Practice Address - Country:US
Practice Address - Phone:201-919-1380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21262255A2300X
MDA006532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer