Provider Demographics
NPI:1932245131
Name:LUDLOW PEDIATRICS, INC.
Entity Type:Organization
Organization Name:LUDLOW PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-589-9494
Mailing Address - Street 1:77 WINSOR ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3469
Mailing Address - Country:US
Mailing Address - Phone:413-589-9494
Mailing Address - Fax:413-589-0774
Practice Address - Street 1:77 WINSOR ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3469
Practice Address - Country:US
Practice Address - Phone:413-589-9494
Practice Address - Fax:413-589-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9728171Medicaid