Provider Demographics
NPI:1366433674
Name:CLAUSTRO, LUDGERIO ZABALA (MD)
Entity type:Individual
Prefix:DR
First Name:LUDGERIO
Middle Name:ZABALA
Last Name:CLAUSTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX CVPI
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-1100
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:276-964-1376
Practice Address - Street 1:1 CLINIC DR
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1102
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1376
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101024859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080186223OtherRAILROAD MEDICARE
141655OtherANTHEM BCBS
VA5644691Medicaid
WV1812319-000Medicaid
KY64053663Medicaid
KY64053663Medicaid