Provider Demographics
NPI:1700963360
Name:LUDWIG, DANA WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:WALTER
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 1:336 DOLPHIN ISLE
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1416
Mailing Address - Country:US
Mailing Address - Phone:650-303-0886
Mailing Address - Fax:
Practice Address - Street 1:336 DOLPHIN ISLE
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1416
Practice Address - Country:US
Practice Address - Phone:650-303-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine