Provider Demographics
NPI:1750439147
Name:LUDIVICO, CHARLES L (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:LUDIVICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:STE 402
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015
Mailing Address - Country:US
Mailing Address - Phone:610-868-1336
Mailing Address - Fax:610-332-2436
Practice Address - Street 1:701 OSTRUM ST STE 302
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:610-868-1336
Practice Address - Fax:610-332-2436
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012628E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA149574KT13Medicare ID - Type Unspecified
B39915Medicare UPIN