Provider Demographics
NPI:1093946246
Name:FERRIS, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FERRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12252 WILLIAMS RD SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12252 WILLIAMS RD SE
Practice Address - Street 2:SUITE 301
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7987
Practice Address - Country:US
Practice Address - Phone:240-362-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005678363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
16594VV6OtherMEDICARE PTAN
2120156OtherHIGHMARK