1871564872 NPI number — DR. JOHN W LUDGATE PH.D.

Table of content: DR. JOHN W LUDGATE PH.D. (NPI 1871564872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871564872 NPI number — DR. JOHN W LUDGATE PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUDGATE
Provider First Name:
JOHN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871564872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 BILTMORE AVE
Provider Second Line Business Mailing Address:
SUITE 2E
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28801-4543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-359-1177
Provider Business Mailing Address Fax Number:
828-350-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 BILTMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 2E
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-350-1177
Provider Business Practice Location Address Fax Number:
828-350-1188
Provider Enumeration Date:
01/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  3540 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 285526 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 007703171 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220800 . This is a "VALUEOPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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