Healthcare Provider Details

I. General information

NPI: 1205841772
Provider Name (Legal Business Name): JUDITH A. LEDMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1851
US

IV. Provider business mailing address

933 BRADBURY SE SUITE 2222
ALBUQUERQUE NM
87106-4301
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5894
  • Fax:
Mailing address:
  • Phone: 505-272-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number76-217
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: