Healthcare Provider Details

I. General information

NPI: 1457336216
Provider Name (Legal Business Name): HEATHER P FERRILL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN STREET
SACO ME
04072
US

IV. Provider business mailing address

1 MEDICAL CENTER DR PO BOX 626
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-1407
  • Fax: 207-284-6291
Mailing address:
  • Phone: 207-282-9080
  • Fax: 207-284-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1712
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: