Provider Demographics
NPI:1336196450
Name:CREARY, LUDLOW BARRINGTON (MD)
Entity Type:Individual
Prefix:
First Name:LUDLOW
Middle Name:BARRINGTON
Last Name:CREARY
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 1:2370 JUPITER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2026
Mailing Address - Country:US
Mailing Address - Phone:213-804-3476
Mailing Address - Fax:
Practice Address - Street 1:266 S HARVARD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4372
Practice Address - Country:US
Practice Address - Phone:323-851-1210
Practice Address - Fax:323-851-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C246670Medicaid