Provider Demographics
NPI:1437170263
Name:LEDBETTER, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 HERRICK ST
Mailing Address - Street 2:STE 219
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-0714
Mailing Address - Fax:978-927-9135
Practice Address - Street 1:75 HERRICK ST
Practice Address - Street 2:STE 219
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-0714
Practice Address - Fax:978-927-9135
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA54518208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3003418Medicaid
B76227Medicare UPIN
MA3003418Medicaid