Provider Demographics
NPI:1245234806
Name:FERRITTO, JERAULD D JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:JERAULD
Middle Name:D
Last Name:FERRITTO
Suffix:JR
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 1:3774 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2235
Mailing Address - Country:US
Mailing Address - Phone:614-875-8211
Mailing Address - Fax:614-875-0769
Practice Address - Street 1:3774 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2235
Practice Address - Country:US
Practice Address - Phone:614-875-8211
Practice Address - Fax:614-875-0769
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001780213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331466Medicaid
OH0331466Medicaid
OHFE0435402Medicare PIN