Provider Demographics
NPI:1861496614
Name:FERRIS, FRED Z (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:Z
Last Name:FERRIS
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:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:2900 LAMB CIRCLE
Practice Address - Street 2:SUITE 190, BLUE RIDGE NEPHROLOGY ASSOCIATES PC
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:540-633-5650
Practice Address - Fax:540-633-5659
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16546174400000X
VA0101246737207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81031OtherBLUE CROSS BLUE SHIELD
KYC69421Medicare UPIN