Provider Demographics
NPI:1245395185
Name:FERRIS, ANDREW GILLETT (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GILLETT
Last Name:FERRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1090 NE GATEWAY CT NE
Practice Address - Street 2:STE 204
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2414
Practice Address - Country:US
Practice Address - Phone:704-403-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200601962207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC144VAOtherBCBS
NC205767176OtherPRACTICE TAX ID
NC7280907OtherAETNA
NC809226Other(BCBS) PARTNERS MEDICARE
NCP00658179OtherMEDICARE RR
NC194997OtherMEDCOST
NC2741965OtherUNITED HEALTHCARE
NC2403472OtherMEDICARE PIN, EFF 2/12/07
NC1324912OtherCIGNA HEALTHCARE
NC2342616OtherMEDICARE GROUP
NC5905721OtherMEDICAID &/OR CAROLINA AC
NC205767176OtherPRACTICE TAX ID
NCP00658179OtherMEDICARE RR