Provider Demographics
NPI:1154006526
Name:FERREIRA, AVERY NIKOLAS (DO)
Entity type:Individual
Prefix:DR
First Name:AVERY
Middle Name:NIKOLAS
Last Name:FERREIRA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:AVERY
Other - Middle Name:NIKOLAS
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1500 LANSDOWNE AVE
Mailing Address - Street 2:GME OFFICE
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1200
Mailing Address - Country:US
Mailing Address - Phone:718-662-4825
Mailing Address - Fax:
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:GME OFFICE
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:718-662-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT023641208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice