Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 20010510A | IN |
NPI | 1376600767 |
---|---|
Provider Name | Bart Ferraro |
First Address | Indianapolis, IN 46202-1305 |
Second Address | Indianapolis, IN 46202-1305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 13/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000271870 | ANTHEM BCBS (01) | IN |
057945000 | MAGELLAN (01) | IN |
100068930 | (05) | IN |
88448 | CIGNA (01) | IN |