Provider Demographics
NPI: | 1649385634 |
---|---|
Name: | LEDAKIS, PANAYOTIS (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | PANAYOTIS |
Middle Name: | |
Last Name: | LEDAKIS |
Suffix: | |
Gender: | M |
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: | 227 ST PAUL PLACE |
Mailing Address - Street 2: | 4TH FLOOR |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21202-2001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-783-5858 |
Mailing Address - Fax: | 410-783-5864 |
Practice Address - Street 1: | 227 ST PAUL PLACE |
Practice Address - Street 2: | 4TH FLOOR |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21202-2001 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-783-5858 |
Practice Address - Fax: | 410-783-5864 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-20 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D047934 | 207RH0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
7223044 | Other | AETNA | |
64123801 | Other | CAREFIRST MD | |
R8440003 | Other | CAREFIRST DC | |
R8440003 | Other | CAREFIRST DC | |
MD | 123LH359 | Medicare ID - Type Unspecified |