Healthcare Provider Details

I. General information

NPI: 1962536516
Provider Name (Legal Business Name): RICHARD T. FERRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6832 MARKET ST SUITE A
WILMINGTON NC
28405-9723
US

IV. Provider business mailing address

PO BOX 572
WRIGHTSVILLE BEACH NC
28480-0572
US

V. Phone/Fax

Practice location:
  • Phone: 910-859-2273
  • Fax:
Mailing address:
  • Phone: 919-698-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9801257
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number28120
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number9801257
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: