Provider Demographics
NPI:1972728145
Name:LUDOLPH, CAROL ANN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:LUDOLPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6924
Mailing Address - Country:US
Mailing Address - Phone:267-626-2018
Mailing Address - Fax:267-636-5205
Practice Address - Street 1:802 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6924
Practice Address - Country:US
Practice Address - Phone:267-626-2018
Practice Address - Fax:267-636-5205
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033514E207T00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001032090001Medicaid
PANE046129Medicare ID - Type Unspecified
PA0001032090001Medicaid