Healthcare Provider Details

I. General information

NPI: 1861450041
Provider Name (Legal Business Name): LUDWIG J EGLSEDER III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CYNWOOD DR
EASTON MD
21601-3869
US

IV. Provider business mailing address

1602 NEWPORT GAP PIKE
WILMINGTON DE
19808-6208
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-8824
  • Fax: 410-822-4863
Mailing address:
  • Phone: 302-633-5840
  • Fax: 302-633-5844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateDE

VIII. Authorized Official

Name: DR. LUDWIG J EGLSEDER III
Title or Position: OWNER
Credential: MD
Phone: 410-820-8824