Basic Information
| Provider Information | |||||||||
| NPI: | 1104818103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRANTE | ||||||||
| FirstName: | GIOVANNI | ||||||||
| MiddleName: | AGOSTINO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023023308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089417000 | ||||||||
| FaxNumber: | 5089410893 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023023308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1508941700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 58121 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0101254593 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 48573 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 48573 | TN | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 0101254593 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 58121 | MA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | VVB935A | 01 | VA | MEDICARE | OTHER | 34698 | 01 | FALLON | OTHER | J06780 | 01 | BC/BS | OTHER | 3024393 | 05 | MA | MEDICAID | 1104818103 | 05 | VA | MEDICAID | Q008560 | 05 | TN | MEDICAID |