Provider Demographics
NPI:1376582130
Name:FERRIS, JULIAN CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:CAMPBELL
Last Name:FERRIS
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 1:133 FAIFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:ST. ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478
Mailing Address - Country:US
Mailing Address - Phone:802-524-5911
Mailing Address - Fax:802-527-1057
Practice Address - Street 1:133 FAIFIELD STREET
Practice Address - Street 2:
Practice Address - City:ST. ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478
Practice Address - Country:US
Practice Address - Phone:802-524-5911
Practice Address - Fax:802-527-1057
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001374207R00000X, 208M00000X
VT042-0012835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist