=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922813898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORIAH FERULLO PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18022 COTTAGE GARDEN DR APT 204
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20874-5825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-398-6885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18022 COTTAGE GARDEN DR APT 204
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20874-5825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-398-6885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | C0007089
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------