Provider Demographics
NPI:1265510424
Name:JOHN A FERULLO MD FACC
Entity Type:Organization
Organization Name:JOHN A FERULLO MD FACC
Other - Org Name:JOHN A FERULLO MS FACC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FERULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-363-9054
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:655
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608
Mailing Address - Country:US
Mailing Address - Phone:508-363-9335
Mailing Address - Fax:508-363-6111
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:655
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-363-9335
Practice Address - Fax:508-363-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17087OtherB SHIELD GROUP
MA2072432Medicaid
MAM17087OtherB SHIELD GROUP
MAM17087OtherB SHIELD GROUP
MA2072432Medicaid