Basic Information
| Provider Information | |||||||||
| NPI: | 1841218344 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRISS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ALDEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 WRIGHT STREET | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010691138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132837651 | ||||||||
| FaxNumber: | 4132845117 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 WRIGHT ST | ||||||||
| Address2: | |||||||||
| City: | PALMER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010691138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132845400 | ||||||||
| FaxNumber: | 4132845114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 159373 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 945948 | 01 | NETWORK HEALTH | OTHER | 159373 | 01 | TUFTS COMM HEALTH PLAN | OTHER | 3547811 | 01 | HEALTHSOURCE CMHC | OTHER | 3192580 | 05 | MA | MEDICAID | 3200085 | 01 | UNITED HEALTH CARE | OTHER | W201492 | 01 | CIGNA | OTHER | 25771 | 01 | HARVARD PILGRIM | OTHER | 41609 | 01 | FALLON COMM HEALTH PLAN | OTHER | J21093 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 159373 | 01 | CONNECTICARE | OTHER |