Provider Demographics
NPI:1861450041
Name:LUDWIG J EGLSEDER III
Entity Type:Organization
Organization Name:LUDWIG J EGLSEDER III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUDWIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:EGLSEDER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:410-820-8824
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:503 CYNWOOD DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3869
Practice Address - Country:US
Practice Address - Phone:410-820-8824
Practice Address - Fax:410-822-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405661200Medicaid
MD439CLOtherBCBS-MD
MD054NMedicare ID - Type Unspecified
MD405661200Medicaid