Provider Demographics
NPI:1215966478
Name:LADSON, SEAN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:LADSON
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:PO BOX 715181
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5181
Mailing Address - Country:US
Mailing Address - Phone:502-753-0680
Mailing Address - Fax:502-753-0687
Practice Address - Street 1:4612 CROSSFIELD CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1425
Practice Address - Country:US
Practice Address - Phone:502-432-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY358272085R0202X, 2085B0100X, 2085U0001X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525510Medicaid
KY64064314Medicaid
KY00151014Medicare PIN
KY64064314Medicaid
IN200525510Medicaid
KY00857002Medicare PIN
H29881Medicare UPIN
KY0935398Medicare PIN