Provider Demographics
NPI:1073502522
Name:DOMINIC N. FERRERA, MD, INC.
Entity Type:Organization
Organization Name:DOMINIC N. FERRERA, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:FERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-283-7300
Mailing Address - Street 1:380 SUMMIT AVENUE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7300
Mailing Address - Fax:740-282-5256
Practice Address - Street 1:1 ROSS PARK BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2671
Practice Address - Country:US
Practice Address - Phone:740-283-7300
Practice Address - Fax:740-282-5256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-041927F208800000X
WV13862208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0385328Medicaid
OH791341118OtherRAILROAD MEDICARE
OH0385328Medicaid