Provider Demographics
NPI:1245222777
Name:FERRARA, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:FERRARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 2015
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8253
Mailing Address - Country:US
Mailing Address - Phone:314-251-1790
Mailing Address - Fax:314-251-1790
Practice Address - Street 1:625 S NEW BALLAS RD
Practice Address - Street 2:SUITE 2015
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8253
Practice Address - Country:US
Practice Address - Phone:314-251-1700
Practice Address - Fax:314-251-5804
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1B71207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202148508Medicaid
MOR1B71OtherLICENSE
MOB18599Medicare UPIN
MO147540004Medicare PIN
MOR1B71OtherLICENSE
MO563751Medicare ID - Type UnspecifiedMEDICARE
MOMA1160003Medicare PIN
MO202148508Medicaid
MO563751OtherMALPRACTICE