Provider Demographics
NPI:1811993447
Name:FERRIS, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FERRIS
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 1:188 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1869
Mailing Address - Country:US
Mailing Address - Phone:781-221-5653
Mailing Address - Fax:
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:781-329-1400
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
153280OtherTUFTS BENEFIT ADMINISTRAT
3174531OtherMASS HEALTH (DIV OF MEDSV
G11682OtherFIRST SENIORITY
G11682OtherHARVARD PILGRIM POS
G11682OtherHARVARD PILGRIM
J18335OtherBS-BLUECARE ELECT
G11682OtherHARVARD PILGRIM PPO
0011199OtherNEIGHBORHOOD HEALTH PLAN
153280OtherTUFTS TOTAL HEALTH PLAN
J18335OtherHMO BLUE/BLUE CHOICE
7999027OtherHEALTHSOURCE MASSACHUSETT
27394OtherCHILDRENS MEDICAL SECURIT
153280OtherTUFTS
12-01710OtherUNITED HEALTHCARE PPO
153280OtherTUFTS COMMONWEALTH PPO
7999027OtherCIGNA HEALTH CARE
J18335OtherBLUE SHIELD INDEMNITY
153280OtherTUFTS
3174531OtherMASS HEALTH (DIV OF MEDSV