Healthcare Provider Details

I. General information

NPI: 1922282466
Provider Name (Legal Business Name): PHILIP J. FERRIS, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
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: PHILIP JEFFREY FERRIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 443-777-6225