Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD028241E | PA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD028241E | PA |
NPI | 1124058227 |
---|---|
Provider Name | Jack Ludmir |
First Address | Philadelphia, PA 19107-4420 |
Second Address | Philadelphia, PA 19107-4420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 12/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001082931 | (05) | PA |
B36218 | (02) | PA |