Provider Demographics
NPI:1528056439
Name:FERULLO, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:FERULLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUITE #655
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-9335
Mailing Address - Fax:508-363-6111
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE #655
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-9335
Practice Address - Fax:508-363-6111
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA42974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2072432Medicaid
MA448620OtherCIGNA
MA983631OtherNETWORK HEALTH
MA0000808OtherNEIGHBORHOOD HELATH
MA042974OtherTUFTS HEALTHCARE
MA060050947OtherRAILROAD MEDICARE
MA19068OtherFALLON HEALTHCARE
MA2580562OtherEVERCARE
MA3577OtherHARVARD PILGRIM HEALTH
MA4589594OtherAETNA HEALTCARE
MAM17087OtherBLUE CROSS BLUE SHIELD
MA2039033OtherUS HEALTHCARE
MA2072432Medicaid
MA2039033OtherUS HEALTHCARE