Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT00471 | RI |
Y | 213ES0000X | Sports Medicine | AT00471 | RI |
NPI | 1053941526 |
---|---|
Provider Name | Amy Ludovici |
First Address | Southborough, MA 01772-1440 |
Second Address | Providence, RI 02918-7001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 23/01/2020 |