Provider Demographics
NPI:1891794889
Name:FERRARA, ALAN A (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:A
Last Name:FERRARA
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 30
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0030
Mailing Address - Country:US
Mailing Address - Phone:606-638-4888
Mailing Address - Fax:606-638-9003
Practice Address - Street 1:HIGHWAY 644
Practice Address - Street 2:SUITE 203
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-4888
Practice Address - Fax:606-638-9003
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY324542080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY32454OtherSTATE LICENSE