Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0101254593 | VA |
N | 208600000X | Surgeon | 0101254593 | VA |
N | 208200000X | Surgeon | 48573 | TN |
N | 208600000X | Surgeon | 48573 | TN |
N | 208200000X | Surgeon | 58121 | MA |
N | 208600000X | Surgeon | 58121 | MA |
Y | 2086S0129X | Vascular Surgeon | 0101254593 | VA |
N | 2086S0129X | Vascular Surgeon | 48573 | TN |
N | 2086S0129X | Vascular Surgeon | 58121 | MA |
NPI | 1104818103 |
---|---|
Provider Name | Giovanni Agostino Ferrante |
First Address | Abingdon, VA 24211-7664 |
Second Address | Abingdon, VA 24211-7664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104818103 | (05) | VA |
3024393 | (05) | MA |
34698 | FALLON (01) | |
B98075 | (02) | |
J06780 | BC/BS (01) | |
Q008560 | (05) | TN |
VVB935A | MEDICARE (01) | VA |