Basic Information
Provider Information
NPI: 1740236405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FERRARO
FirstName: ANGELO
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 122 W 7TH AVE
Address2: SUITE 310
City: SPOKANE
State: WA
PostalCode: 992042349
CountryCode: US
TelephoneNumber: 5098387711
FaxNumber: 5097474664
Practice Location
Address1: 122 W 7TH AVE
Address2: SUITE 310
City: SPOKANE
State: WA
PostalCode: 992042349
CountryCode: US
TelephoneNumber: 5098387711
FaxNumber: 5097474664
Other Information
ProviderEnumerationDate: 05/25/2006
LastUpdateDate: 08/26/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD31032WAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0000XM6726IDN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0000XMD28849ORN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011XM6726IDN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
207RI0011XMD28849ORN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
207RC0000XMD00031032WAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RI0011XMD28849WAN Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

ID Information
IDTypeStateIssuerDescription
00321300005ID MEDICAID


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