Provider Demographics
NPI:1952300469
Name:CAVALIERE, LUDWIG V (MD)
Entity Type:Individual
Prefix:
First Name:LUDWIG
Middle Name:V
Last Name:CAVALIERE
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 1:640 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3206
Mailing Address - Country:US
Mailing Address - Phone:478-745-5455
Mailing Address - Fax:478-745-2915
Practice Address - Street 1:640 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3206
Practice Address - Country:US
Practice Address - Phone:478-745-5455
Practice Address - Fax:478-745-2915
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33290207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000430911MMedicaid
110045177OtherRAILROAD MEDICARE
GA000430911AEMedicaid
GA000430911AFMedicaid
GA000430911HMedicaid
GA000430911AAMedicaid
GA000430911AHMedicaid
GA000430911ZMedicaid
GA000430911GMedicaid
GA000430911YMedicaid
GA000430911ADMedicaid
GA000430911UMedicaid
281691OtherBLUECROSS
GA000430911NMedicaid
GA000430911SMedicaid
GA000430911ACMedicaid
GA000430911AGMedicaid
GA000430911EMedicaid
GA000430911LMedicaid
GA000430911TMedicaid
GA000430911VMedicaid
GA000430911XMedicaid
GA000430911XMedicaid