Active NPI
Avital Brena Ludomirsky, MD, MPP
- Pediatric Cardiology Physician
- Philadelphia, PA
National Provider Identifier
1770945677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- MT224887
- Practice address
- 3401 Civic Center Blvd
Division of Pediatric Cardiology
Philadelphia, PA 19104 - Phone
- (267) 455-9892
- NPI assigned
- Mar 22, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 278141 | MA | |
| Pediatrics Physician | 208000000X | 65164 | CT | |
| Pediatric Cardiology Physician | 2080P0202X | MT224887 | PA | Primary |
Addresses
Primary practice location
3401 Civic Center Blvd
Division of Pediatric Cardiology
Philadelphia, PA 19104
Mailing address
2205 Kimball St
Philadelphia, PA 19146-2523
Phone (734) 678-5201
Other practice location 1
1 Park St
New Haven, CT 06504-8901
Phone (203) 785-4081
Other practice location 2
300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT224887 | PA | MD | Pediatric Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656028800000",
"number": "1770945677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2205 KIMBALL ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191462523",
"telephone_number": "734-678-5201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 CIVIC CENTER BLVD",
"address_2": "DIVISION OF PEDIATRIC CARDIOLOGY",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19104",
"telephone_number": "267-455-9892"
}
],
"practiceLocations": [
{
"address_1": "1 Park St",
"address_purpose": "LOCATION",
"city": "New Haven",
"state": "CT",
"postal_code": "065048901",
"country_code": "US",
"telephone_number": "203-785-4081",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 Longwood Ave",
"address_purpose": "LOCATION",
"city": "Boston",
"state": "MA",
"postal_code": "021155724",
"country_code": "US",
"telephone_number": "617-355-6000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LUDOMIRSKY",
"first_name": "AVITAL",
"middle_name": "BRENA",
"name_prefix": "Dr.",
"credential": "MD, MPP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-03-22",
"last_updated": "2022-06-24",
"certification_date": "2022-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "278141",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "65164",
"primary": false
},
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "PA",
"license": "MT224887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.