Provider Demographics
NPI:1518982032
Name:FERRARO, JOSEPH VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VINCENT
Last Name:FERRARO
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 1:5537 DEALE CHURCHTON RD # 533
Mailing Address - Street 2:
Mailing Address - City:CHURCHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20733-9998
Mailing Address - Country:US
Mailing Address - Phone:352-327-2140
Mailing Address - Fax:
Practice Address - Street 1:2729 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-4008
Practice Address - Country:US
Practice Address - Phone:703-836-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68463208D00000X
MDD00684632081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417075000Medicaid
MD417075000Medicaid