Provider Demographics
NPI:1477529329
Name:LUDERER, ROBERT C (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:LUDERER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DOCTORS LN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8515
Mailing Address - Country:US
Mailing Address - Phone:814-226-3470
Mailing Address - Fax:814-226-3479
Practice Address - Street 1:150 DOCTORS LN
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8516
Practice Address - Country:US
Practice Address - Phone:814-226-3480
Practice Address - Fax:814-226-3489
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003132207R00000X
PAOS003132L207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006061970008Medicaid
PA167522R4WMedicare PIN