Healthcare Provider Details

I. General information

NPI: 1225141146
Provider Name (Legal Business Name): MICHAEL L LADWIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BEEKMAN ST
PLATTSBURGH NY
12901-1438
US

IV. Provider business mailing address

36 FLAGLAR DR
PLATTSBURGH NY
12901-1315
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-6323
  • Fax: 518-561-6325
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number213220
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number231220
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number213220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: