Basic Information
| Provider Information | |||||||||
| NPI: | 1548230493 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERRERAS | ||||||||
| FirstName: | HERMINIA | ||||||||
| MiddleName: | DE GUZMAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044032660 | ||||||||
| FaxNumber: | 7044032670 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044032660 | ||||||||
| FaxNumber: | 7044032670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0008X | 20020035 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Neurodevelopmental Disabilities | 2084N0402X | 20020035 | NC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology |
ID Information
| ID | Type | State | Issuer | Description | 1357R | 01 | NC | BCBS OF NC | OTHER | NC1491 | 05 | SC | MEDICAID | 3019645 | 01 | CIGNA | OTHER | 7837542 | 01 | NC | AETNA | OTHER | 891357R | 05 | NC | MEDICAID | D3848 | 01 | MEDCOST | OTHER |