Provider Demographics
NPI:1710949391
Name:LEDRICK, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LEDRICK
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-3014
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068001207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000377196OtherBC/BS NUMBER ST.CHARLES
OH0229434Medicaid
MI104808619Medicaid
OHP00212618OtherRAILROAD MEDICARE NUMBER
MI104737079Medicaid
OH727154OtherBUCKEYE COMMUNITY NUMBER
OH000000360653OtherBC/BS IND PROVIDER NUMBER
OH104808619Medicaid
OHP00280662OtherRAILROAD # AT ST. CHARLES
OH000000360653OtherBC/BS IND PROVIDER NUMBER
OH000000377196OtherBC/BS NUMBER ST.CHARLES
OHG25219Medicare UPIN