Provider Demographics
NPI:1275617722
Name:FERRARO, DOROTHY ROEDEL (NP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ROEDEL
Last Name:FERRARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 W BROAD ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3661
Mailing Address - Country:US
Mailing Address - Phone:203-276-2370
Mailing Address - Fax:203-276-2378
Practice Address - Street 1:166 W BROAD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3661
Practice Address - Country:US
Practice Address - Phone:203-276-2370
Practice Address - Fax:203-276-2378
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004457363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS44476Medicare UPIN