Provider Demographics
NPI:1467159780
Name:FERRIS, MADELINE ANN
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:ANN
Last Name:FERRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1604
Mailing Address - Country:US
Mailing Address - Phone:315-857-5738
Mailing Address - Fax:
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5332
Practice Address - Country:US
Practice Address - Phone:315-735-4496
Practice Address - Fax:315-735-7066
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program