Provider Demographics
NPI:1467426544
Name:FERRARA, VINCENT LOUIS (MDM)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:LOUIS
Last Name:FERRARA
Suffix:
Gender:M
Credentials:MDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1203
Mailing Address - Country:US
Mailing Address - Phone:215-884-1929
Mailing Address - Fax:215-884-5286
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:SUITE 708
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-379-2600
Practice Address - Fax:215-663-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008053-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30834AOtherMERCY
PA4421025OtherAETNA
PA3855OtherUSHC
PA0797446Medicaid
PA165532OtherBC/BS/PC
PA1245433-002OtherCIGNA
PA0797446Medicaid
PA017135GBPMedicare PIN