Provider Demographics
NPI:1730184938
Name:LUDWICKI, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:LUDWICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1628
Mailing Address - Country:US
Mailing Address - Phone:302-684-0561
Mailing Address - Fax:302-684-3563
Practice Address - Street 1:424 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1628
Practice Address - Country:US
Practice Address - Phone:302-684-0561
Practice Address - Fax:302-684-3563
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100049422080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000854201Medicaid
DE0000854201Medicaid