Basic Information
| Provider Information | |||||||||
| NPI: | 1194719641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUEDKE | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 1049 CLAYMONT DR | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245024481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345821600 | ||||||||
| FaxNumber: | 4345824807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A0401X | 0101031815 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084F0202X | 0101031815 | VA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry | 2084P0800X | 0101031815 | VA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 186467 | 01 | ANTHEM PROVIDER NUMBER | OTHER | 001238 | 01 | VALUE OPTIONS PROVIDER NU | OTHER | 84228M | 01 | SENTARA/OPTIMA PROVIDER N | OTHER | 20-3639329 | 01 | PCHP PROVIDER NUMBER | OTHER | 203639329001 | 01 | TRICARE PROVIDER NUMBER | OTHER | 70985 | 01 | CIGNA BEHAVIOR PROVIDER N | OTHER | 010220751 | 05 | VA | MEDICAID |