Provider Demographics
NPI:1396776225
Name:FERLAUTO, GERALD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:JOSEPH
Last Name:FERLAUTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:J
Other - Last Name:FERLAUTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 NORTH ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2629
Practice Address - Country:US
Practice Address - Phone:864-331-1300
Practice Address - Fax:864-331-1447
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC79332080N0001X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC079337Medicaid
SCD750767951Medicare PIN
SC079337Medicaid
SC079337Medicaid
SC57-6007863032OtherBCBS OF SC
SCD750763640Medicare PIN