Healthcare Provider Details

I. General information

NPI: 1316047020
Provider Name (Legal Business Name): DAVID FERRERO SR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FAIRMONT AVE SUITE 201
FAIRMONT WV
26554-5141
US

IV. Provider business mailing address

900 FAIRMONT AVE SUITE 201
FAIRMONT WV
26554-5141
US

V. Phone/Fax

Practice location:
  • Phone: 304-367-1111
  • Fax: 304-367-1128
Mailing address:
  • Phone: 304-367-1111
  • Fax: 304-367-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number248
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC-003441-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: