Provider Demographics
NPI:1841218344
Name:FERRISS, JOHN ALDEN III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALDEN
Last Name:FERRISS
Suffix:III
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 1:40 WRIGHT STREET
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:413-284-5117
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5114
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159373207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
945948OtherNETWORK HEALTH
159373OtherTUFTS COMM HEALTH PLAN
3547811OtherHEALTHSOURCE CMHC
MA3192580Medicaid
3200085OtherUNITED HEALTH CARE
W201492OtherCIGNA
25771OtherHARVARD PILGRIM
41609OtherFALLON COMM HEALTH PLAN
J21093OtherBLUE CROSS BLUE SHIELD
159373OtherCONNECTICARE
A29787Medicare ID - Type Unspecified
MA3192580Medicaid