1841218344 NPI number — JOHN ALDEN FERRISS III MD

Table of content: JOHN ALDEN FERRISS III MD (NPI 1841218344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841218344 NPI number — JOHN ALDEN FERRISS III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRISS
Provider First Name:
JOHN
Provider Middle Name:
ALDEN
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841218344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WRIGHT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01069-1138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-283-7651
Provider Business Mailing Address Fax Number:
413-284-5117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WRIGHT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01069-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-284-5400
Provider Business Practice Location Address Fax Number:
413-284-5114
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  159373 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 945948 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 159373 . This is a "TUFTS COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3547811 . This is a "HEALTHSOURCE CMHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3192580 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3200085 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W201492 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25771 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41609 . This is a "FALLON COMM HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: J21093 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 159373 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".




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