Provider Demographics
NPI:1770551715
Name:LADDIS, THEODOROS (MD)
Entity type:Individual
Prefix:DR
First Name:THEODOROS
Middle Name:
Last Name:LADDIS
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1368
Mailing Address - Country:US
Mailing Address - Phone:518-886-5080
Mailing Address - Fax:518-886-5081
Practice Address - Street 1:254 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1037
Practice Address - Country:US
Practice Address - Phone:518-886-5080
Practice Address - Fax:518-886-5081
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217082207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02067247Medicaid
H14429Medicare UPIN
NY02067247Medicaid