Healthcare Provider Details

I. General information

NPI: 1700171675
Provider Name (Legal Business Name): MATTHEW C. FERRONI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY UROLOGY CLINIC 701 10TH STREET SE
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

MERCY UROLOGY CLINIC 701 10TH STREET SE
CEDAR RAPIDS IA
52401
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6865
  • Fax: 319-398-6635
Mailing address:
  • Phone: 319-398-6865
  • Fax: 319-398-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number69106
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD-48990
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMT200097
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerMEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: