Provider Demographics
NPI:1295172161
Name:LUDWIG, EDILENE
Entity type:Individual
Prefix:
First Name:EDILENE
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 SCHOFFERS RD
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-9475
Mailing Address - Country:US
Mailing Address - Phone:610-689-8826
Mailing Address - Fax:610-678-9636
Practice Address - Street 1:1381 SCHOFFERS RD
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-9475
Practice Address - Country:US
Practice Address - Phone:610-689-8826
Practice Address - Fax:610-678-9636
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076441Medicare UPIN