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NPI Code Detail

MEDICARE: DANIEL ANTHONY LUDLOW LAT, ATC

MEDICARE: DANIEL ANTHONY LUDLOW LAT, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerA0001095MD

General Provider Information

NPI Number : 1053977900
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL ANTHONY LUDLOW LAT, ATC
Provider Business Mailing Address
First Line : 6913 DONACHIE RD APT D
Second Line :
City : BALTIMORE
State : MD
Zip : 21239-1109
Country : US
Telephone Number : 443-900-7294
Fax Number :
Provider Business Practice Location Address
First Line : 5500 KNOLL NORTH DR STE 150
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2476
Country : US
Telephone Number : 443-542-0062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2019
Last Update Date : 05/16/2019

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