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General NPI Number Information
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NPI Number | 1770945677
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Entity Type | Individual
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Provider Name | AVITAL BRENA LUDOMIRSKY MD, MPP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC CARDIOLOGY
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 267-455-9892
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 KIMBALL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19146-2523
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Country | US
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Telephone | 734-678-5201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 278141
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 65164
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MT224887
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License Number State | PA
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