Provider Demographics
NPI:1801801246
Name:DORADO, LUDIVINA R (MD)
Entity type:Individual
Prefix:
First Name:LUDIVINA
Middle Name:R
Last Name:DORADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 SOUTH 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638
Mailing Address - Country:US
Mailing Address - Phone:740-532-6634
Mailing Address - Fax:
Practice Address - Street 1:2213 SOUTH 9TH STREET
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638
Practice Address - Country:US
Practice Address - Phone:740-532-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036407207RC0000X
KY36853207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0234642Medicaid
KY64043789OtherMEDICAID
KY1947701OtherMEDICARE
KY000000590543OtherANTHEM BCBS
OH0402784Medicare PIN
OH0234642Medicaid
KY000000590543OtherANTHEM BCBS
B77445Medicare UPIN
KY00888001Medicare PIN