Healthcare Provider Details

I. General information

NPI: 1073502522
Provider Name (Legal Business Name): DOMINIC N. FERRERA, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROSS PARK BLVD SUITE 103
STEUBENVILLE OH
43952-2671
US

IV. Provider business mailing address

380 SUMMIT AVENUE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 740-283-7300
  • Fax: 740-282-5256
Mailing address:
  • Phone: 740-283-7300
  • Fax: 740-282-5256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13862
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35-041927F
License Number StateOH

VIII. Authorized Official

Name: DR. DOMINIC N. FERRERA
Title or Position: OWNER
Credential: MD
Phone: 740-283-7300