Provider Demographics
NPI:1649256496
Name:FERRELL, JOHN L III (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:FERRELL
Suffix:III
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 1:11300 ROCKVILLE PIKE STE 615
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3033
Mailing Address - Country:US
Mailing Address - Phone:202-681-7671
Mailing Address - Fax:844-681-7671
Practice Address - Street 1:11300 ROCKVILLE PIKE STE 615
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3033
Practice Address - Country:US
Practice Address - Phone:202-681-7671
Practice Address - Fax:844-681-7671
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074610208D00000X, 208D00000X
MDD74610207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6588AMedicare PIN
MD248636ZDDBMedicare PIN
VA324557YWAUMedicare PIN
MD248636YVZMedicare PIN