Healthcare Provider Details

I. General information

NPI: 1154464410
Provider Name (Legal Business Name): PHILIP JEFFREY FERRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 FRANKLIN SQUARE DR SUITE 307
BALTIMORE MD
21237-3900
US

IV. Provider business mailing address

9103 FRANKLIN SQUARE DR SUITE 307
BALTIMORE MD
21237-3900
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-6225
  • Fax: 410-391-4016
Mailing address:
  • Phone: 443-777-6225
  • Fax: 410-391-4016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberD0033135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: