Provider Demographics
NPI:1194719641
Name:LUEDKE, GEORGE W (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:LUEDKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4138
Mailing Address - Country:US
Mailing Address - Phone:276-783-1827
Mailing Address - Fax:276-783-2879
Practice Address - Street 1:1049 CLAYMONT DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4481
Practice Address - Country:US
Practice Address - Phone:434-582-1600
Practice Address - Fax:434-582-4807
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010318152084A0401X, 2084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
186467OtherANTHEM PROVIDER NUMBER
001238OtherVALUE OPTIONS PROVIDER NU
84228MOtherSENTARA/OPTIMA PROVIDER N
20-3639329OtherPCHP PROVIDER NUMBER
203639329001OtherTRICARE PROVIDER NUMBER
70985OtherCIGNA BEHAVIOR PROVIDER N
VA010220751Medicaid
70985OtherCIGNA BEHAVIOR PROVIDER N
VA010220751Medicaid
203639329001OtherTRICARE PROVIDER NUMBER