Provider Demographics
NPI:1770632895
Name:LUDWICK, MARK D (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:LUDWICK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 W WELSH POOL ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1233
Mailing Address - Country:US
Mailing Address - Phone:610-363-2664
Mailing Address - Fax:
Practice Address - Street 1:80 W WELSH POOL ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1233
Practice Address - Country:US
Practice Address - Phone:610-363-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002750L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29263Medicare UPIN
PA1022160001Medicare NSC
121714Medicare ID - Type Unspecified