Provider Demographics
NPI:1275553695
Name:FERRARO, PAUL M (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:FERRARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PORTAGE TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3055
Mailing Address - Country:US
Mailing Address - Phone:330-808-1664
Mailing Address - Fax:330-208-0378
Practice Address - Street 1:600 PORTAGE TRL
Practice Address - Street 2:SUITE A
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3055
Practice Address - Country:US
Practice Address - Phone:330-808-1664
Practice Address - Fax:330-208-0378
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008799208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668680Medicaid
4186914Medicare PIN
I56332Medicare UPIN
OH2668680Medicaid