Basic Information
| Provider Information | |||||||||
| NPI: | 1366433674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAUSTRO | ||||||||
| FirstName: | LUDGERIO | ||||||||
| MiddleName: | ZABALA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX CVPI | ||||||||
| Address2: | |||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246411100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769646771 | ||||||||
| FaxNumber: | 2769641376 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 CLINIC DR | ||||||||
| Address2: | CLAYPOOL HILL | ||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246411102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769646771 | ||||||||
| FaxNumber: | 2769641376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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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 | 207Q00000X | 0101024859 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080186223 | 01 | RAILROAD MEDICARE | OTHER | 141655 | 01 | ANTHEM BCBS | OTHER | 5644691 | 05 | VA | MEDICAID | 1812319-000 | 05 | WV | MEDICAID | 64053663 | 05 | KY | MEDICAID |