Provider Demographics
NPI:1689107443
Name:LEDGERWOOD, RHIANNON (MD)
Entity Type:Individual
Prefix:DR
First Name:RHIANNON
Middle Name:
Last Name:LEDGERWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RIORDAN
Other - Middle Name:
Other - Last Name:LEDGERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3302 N MAIN ST APT 11204
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1154
Mailing Address - Country:US
Mailing Address - Phone:502-408-7300
Mailing Address - Fax:
Practice Address - Street 1:36065 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:502-408-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101267911208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty