Provider Demographics
NPI:1730653601
Name:LUDLOW, BONNIE (ARDCS)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:F
Credentials:ARDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 NC 903 S
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-7403
Mailing Address - Country:US
Mailing Address - Phone:704-408-9564
Mailing Address - Fax:
Practice Address - Street 1:2612 NC 903 S
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7403
Practice Address - Country:US
Practice Address - Phone:704-408-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1912322085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound