Provider Demographics
NPI:1639391840
Name:LUDVIGSON, LYNN RAE (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:RAE
Last Name:LUDVIGSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1014 AMHERST ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3342
Mailing Address - Country:US
Mailing Address - Phone:540-536-6788
Mailing Address - Fax:540-662-5778
Practice Address - Street 1:1014 AMHERST ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3342
Practice Address - Country:US
Practice Address - Phone:540-536-6788
Practice Address - Fax:540-662-5778
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012445432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639391840Medicaid
WV3810013954Medicaid
WV3810013954Medicaid