Provider Demographics
NPI:1205883139
Name:FERRARA, BRADLEY J (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
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 1:2325 MARYLAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1760
Mailing Address - Country:US
Mailing Address - Phone:215-657-9393
Mailing Address - Fax:215-657-9398
Practice Address - Street 1:2325 MARYLAND ROAD SUITE 200
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-657-9393
Practice Address - Fax:215-657-9398
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067744L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0872975000OtherAMERIHEALTH
PA7127234OtherAETNA
PA1231975OtherCIGNA
PAFR950467OtherHIGHMARK BCBS
PA1231975OtherCIGNA
PA7127234OtherAETNA
PAH40695Medicare UPIN