Healthcare Provider Details

I. General information

NPI: 1023007911
Provider Name (Legal Business Name): JON B FERBER MS, ATC, CSCS, EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 MANOR HILL RD
BALTIMORE MD
21208-1824
US

IV. Provider business mailing address

3410 MANOR HILL RD
BALTIMORE MD
21208-1824
US

V. Phone/Fax

Practice location:
  • Phone: 410-602-2983
  • Fax:
Mailing address:
  • Phone: 410-602-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: