Provider Demographics
NPI:1700931904
Name:FERRIS, MARY-LOUISE JANNEKE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY-LOUISE
Middle Name:JANNEKE
Last Name:FERRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY-LOUISE
Other - Middle Name:JANNEKE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARY YOUNG
Mailing Address - Street 1:1720 EL CAMINO REAL
Mailing Address - Street 2:STE 165
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3200
Mailing Address - Country:US
Mailing Address - Phone:650-259-5827
Mailing Address - Fax:
Practice Address - Street 1:1720 EL CAMINO REAL
Practice Address - Street 2:SUITE 130
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3224
Practice Address - Country:US
Practice Address - Phone:650-259-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine