Provider Demographics
NPI:1144314311
Name:FERRUCCI, GEOFFREY E (PA)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:E
Last Name:FERRUCCI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 STRAITS TPKE
Mailing Address - Street 2:SUITE #301
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1836
Mailing Address - Country:US
Mailing Address - Phone:203-573-9512
Mailing Address - Fax:203-568-2904
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-6263
Practice Address - Fax:203-573-6707
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001464363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical