Healthcare Provider Details

I. General information

NPI: 1972728145
Provider Name (Legal Business Name): CAROL ANN LUDOLPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 MEADOWBROOK DR
HUNTINGDON VALLEY PA
19006-6924
US

IV. Provider business mailing address

802 MEADOWBROOK DR
HUNTINGDON VALLEY PA
19006-6924
US

V. Phone/Fax

Practice location:
  • Phone: 267-626-2018
  • Fax: 267-636-5205
Mailing address:
  • Phone: 267-626-2018
  • Fax: 267-636-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberMD033514E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD033514E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: