Provider Demographics
NPI:1659470557
Name:FERRER, GUILLERMO E (MD)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:E
Last Name:FERRER
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 1:8 BRENTWOOD DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-257-2116
Mailing Address - Fax:607-257-0315
Practice Address - Street 1:8 BRENTWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-257-2116
Practice Address - Fax:607-257-0315
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161912208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01073096Medicaid
E61865Medicare UPIN
NY52665CMedicare ID - Type Unspecified