Provider Demographics
NPI:1457379836
Name:LUDWIG, BARRY IRWIN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:IRWIN
Last Name:LUDWIG
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 1:2811 WILSHIRE BLVD SUITE 508
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:424-387-4001
Mailing Address - Fax:424-387-4005
Practice Address - Street 1:2811 WILSHIRE BLVD SUITE 508
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:424-387-4001
Practice Address - Fax:424-387-4005
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG367082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0022710Medicaid
CAA46772Medicare UPIN
CAGR0022710Medicaid