Provider Demographics
NPI:1821011966
Name:LADDIS, ANDREAS NONE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREAS
Middle Name:NONE
Last Name:LADDIS
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 1:7 LONGFELLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3621
Mailing Address - Country:US
Mailing Address - Phone:508-320-7895
Mailing Address - Fax:
Practice Address - Street 1:7 LONGFELLOW RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3621
Practice Address - Country:US
Practice Address - Phone:508-320-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA476432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB99333Medicare UPIN
MANO1919Medicare ID - Type Unspecified