Provider Demographics
NPI:1497749410
Name:LEDIG, CARL BRUCE (MD)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:BRUCE
Last Name:LEDIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:104 ENDICOTT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-882-6868
Mailing Address - Fax:978-882-6855
Practice Address - Street 1:104 ENDICOTT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3623
Practice Address - Country:US
Practice Address - Phone:978-882-6868
Practice Address - Fax:978-882-6855
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2012-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA704082208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2062321Medicaid
F97470Medicare UPIN
MA2062321Medicaid