Provider Demographics
NPI:1740384429
Name:FERRENTINO, JERRY A (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:A
Last Name:FERRENTINO
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 1:140 CLARK ST
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8427
Mailing Address - Country:US
Mailing Address - Phone:203-693-3777
Mailing Address - Fax:203-693-3408
Practice Address - Street 1:140 CLARK ST
Practice Address - Street 2:APARTMENT 2
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-8427
Practice Address - Country:US
Practice Address - Phone:203-693-3777
Practice Address - Fax:203-693-3408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032161207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001321611Medicaid
CTF07984Medicare UPIN
CT160001323Medicare ID - Type Unspecified