Basic Information
| Provider Information | |||||||||
| NPI: | 1265688824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRAGO LUDOWIEG | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | EDUARDO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 W 3RD AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293121022 | ||||||||
| FaxNumber: | 2294366946 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 W 3RD AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317011961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293121022 | ||||||||
| FaxNumber: | 2294366946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2008 | ||||||||
| LastUpdateDate: | 02/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 729-L | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 81127 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | P01452045 | 01 | KY | RR MEDICARE | OTHER | 7100358980 | 05 | KY | MEDICAID |