Provider Demographics
NPI:1316030588
Name:FERRUCCI, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:FERRUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 SUMMER ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901
Mailing Address - Country:US
Mailing Address - Phone:203-325-4665
Mailing Address - Fax:203-359-0902
Practice Address - Street 1:833 SUMMER ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901
Practice Address - Country:US
Practice Address - Phone:203-325-4665
Practice Address - Fax:203-359-0902
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001311646Medicaid
E05390Medicare UPIN
CT001311646Medicaid