Provider Demographics
NPI:1568434017
Name:LADIKOS, GEORGE ANGELO (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANGELO
Last Name:LADIKOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 CREEKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6805
Mailing Address - Country:US
Mailing Address - Phone:757-496-2828
Mailing Address - Fax:
Practice Address - Street 1:1721 TAUSIGG BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-0000
Practice Address - Country:US
Practice Address - Phone:757-314-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1008625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant