=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881727352
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTOR LUDEWIG MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 03/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 PLAZA BLVD
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12901-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-562-7462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 PLAZA BLVD
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12901-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-562-7462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VICTOR WERNER LUDEWIG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 518-562-7462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 1123371
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------