Provider Demographics
NPI:1043218506
Name:FERRITTO, JEFFREY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:FERRITTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 S HIGH ST
Mailing Address - Street 2:PO BOX 365
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4011
Mailing Address - Country:US
Mailing Address - Phone:614-497-3066
Mailing Address - Fax:614-497-3068
Practice Address - Street 1:3713 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4011
Practice Address - Country:US
Practice Address - Phone:614-497-3066
Practice Address - Fax:614-497-3068
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1903213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000115763OtherANTHEM BC/BS
OH0457241Medicaid
OH0493622Medicare PIN
000000115763OtherANTHEM BC/BS
OHT80508Medicare UPIN