Provider Demographics
NPI:1669918223
Name:LUDLUM, MAX BRANDON (PA-C)
Entity type:Individual
Prefix:MR
First Name:MAX
Middle Name:BRANDON
Last Name:LUDLUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 MEETING CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6631
Mailing Address - Country:US
Mailing Address - Phone:910-399-7180
Mailing Address - Fax:910-660-8314
Practice Address - Street 1:1902 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-399-7180
Practice Address - Fax:910-660-8314
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1821295668OtherFAMILY PRACTICE
NC1992351910Medicaid