Provider Demographics
NPI:1598803371
Name:LUDDINGTON, NICOLE SHEREE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:SHEREE
Last Name:LUDDINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206
Mailing Address - Country:US
Mailing Address - Phone:513-245-3617
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:234 GOODMAN AVENUE
Practice Address - Street 2:DEPT. OF PSYCHIATRY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-584-8577
Practice Address - Fax:513-584-8198
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY409052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0026958OtherPTAN
IN200863750Medicaid
KY401822OtherTRICARE
KY7100013730Medicaid
IN200863750Medicaid
0878434Medicare PIN
0026958OtherPTAN